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The extent to which observed disparities in access to primary pediatric care are mirrored in student access to school nursing services is unknown. Using school employment records, we linked 1,346 nurses to school districts serving 1,141,495 students in Washington state. The percentage of students who are Black is negatively associated with the student-to-nurse ratio, while the percentage of students eligible for free-or-reduced-price lunch is positively associated, and relative to urban districts, rural districts have higher student-to-nurse ratios. Disparities in access to school nursing services mirror access gaps for pediatric care along socioeconomic status and geography. The increased number of nurses working in districts with more racial/ethnic minority students may play a protective role and ameliorate access gaps observed in pediatric primary care. States can likely use existing employment and licensing data to understand where school nurses work and therefore guide resource allocation decisions.

This study explored relationships between school nurses' diabetes-related attitudes, self-efficacy in diabetes management and education, and care practices. One-hundred fourteen school nurses who have taken care of students with type 1 diabetes in public schools comprised this descriptive study sample. Participants completed online surveys. School nurses' diabetes-related attitudes were not related to their self-efficacy in diabetes education, but nurses' attitudes towards the psychosocial impact of diabetes were significantly related to their self-efficacy in diabetes management, and the number of students with diabetes was a significant contributor to this relationship. Nurses' full-time status and the type of school they worked in were significantly related to their self-efficacy in providing diabetes education. School nurses' positive attitudes about providing care for students with diabetes were related to having a higher level of self-efficacy in providing diabetes management. Based on the findings, recommendations are made for health consolidated schools and full-time school nurses.

The Whole School, Whole Community, Whole Child (WSCC) model is a student-centered approach that focuses on a culture of health to support student success. Despite its use, the empirical evidence supporting the model is unclear. We conducted a scoping review to understand the research supporting WSCC as a model for student/school health. The search included studies published in English language peer-reviewed journals from 2014 to 2020. Eight articles met criteria for review. Overall, findings from this review reveal a relatively small body of research specific to the WSCC model. Because WSCC is presented as a model for schools throughout the United States, the development of a larger body of research supporting the model as an evidence-based framework will enhance credibility and confidence in the model. School nurses, as leaders, coordinators, and advocates, are well positioned to test and disseminate the model to those seeking to introduce WSCC in their school or district.

Background: Care coordination for chronic health conditions is critical to academic success, yet concrete strategies on its operationalization in schools are not well reported in the literature. Type 1 diabetes (T1D) is one such condition that requires a team-based approach to care coordination. The purpose of this study was to gain a deeper understanding of how care coordination for T1D currently operates and identify strategies for its support and facilitation in schools. Methods: Focus groups were conducted with school nurses, parents of T1D children, and providers in each of the 9 Educational Service Districts in Washington State. Recorded notes were analyzed using content analytic techniques. Results: Five major themes emerged from the data, each with 3 to 4 second-order themes. Care coordination depended on family, school, and child developmental contexts, knowledge/experience about T1D among school nurses, teachers, parents, and providers, access and availability of team members, communication, and relationships. Conclusions: Findings highlight the importance of a contextualized and holistic perspective of facilitators and barriers to care coordination in schools. Promoting the development of supportive relationships and effective team-based approaches provides a foundation and informs intersectional care coordination for all children with chronic conditions.

The National School Nurse Workforce Study 2.0 describes the demographic characteristics and distribution patterns, school nursing models and activities, and practice environment among self-reported public school nurses in the United States. A random sample of U.S. public schools was surveyed, stratified by region, school level, and urban/rural locale. A total of 2,827 schools responded, yielding a 38.1% response rate. Using these data, we estimate 78,869 full-time equivalents of school nurses, with 65,052 registered nurses (RN) and 13,817 licensed practical/vocational nurses (LPN/LVN). Findings indicate school nurse distribution differences by region, locale, and income. The predominant model of school nursing practice was the RN only, followed by the RN and LPN model. In general, school nurse respondents felt supported by school staff and parents. Less than half of survey respondents stated they were supervised by an RN. Research, policy, and school nursing practice implications are discussed. [ABSTRACT FROM AUTHOR]

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research. [ABSTRACT FROM AUTHOR]

Background: As students returned to school, school nurses were responsible for infection control, communication, and the preparation of supplies and facilities. School nurses in the Pacific Northwest US demonstrated a higher prevalence of mental health symptoms in the years since the pandemic began, suggesting that their experience may have been unique. Objective: This study aimed to explore the stressors of school nurses in the Pacific Northwest at two time points. Design: This study is a qualitative, descriptive analysis of anonymous survey responses collected in June of 2021 (n = 333) and between October and December 2021 (n = 284). Sample: Self‐identifying school nurses working in K‐12 schools in Washington State were invited to participate. Measurements: Participants completed open‐ended survey questions designed to elicit their experiences during the pandemic. Results: Four themes emerged from the data: (1) isolation from administration and the school community, (2) COVID‐19‐related workload, (3) disorganized and inconsistent communication, and (4) concern for students, themselves, and others. Conclusions: School nurses played a vital public health role during the pandemic. However, their effectiveness may not have been fully utilized and sometimes undermined. Lastly, our findings highlight the difficulties encountered in implementing the changing scientific and public health guidance during the pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine associations between caseload, social determinants, health needs, students meeting grade-level English and Math standards, and attendance. Data from the Washington State Open Data Portal and Report Card were combined with District Health Assessment data from 264 school districts. Analyses of variance and linear stepwise regression analyses were conducted. Key findings indicate significant differences in English and Math outcomes by caseloads, with higher caseload districts have lower percentages of students meeting English and Math standards, but not attendance. Caseload is a significant predictor of students meeting English and Math standards, after controlling for social determinants and district health needs. Findings point to the complexity of school nursing work and builds a foundation to guide future nursing research. Large prospective studies that allow for comprehensive measurement of structure, process and outcomes variables are needed to advance school nursing research. [ABSTRACT FROM AUTHOR]

School nursing practice has changed dramatically over the past 20 years, yet few nationally representative investigations describing the school nursing workforce have been conducted. The National School Nurse Workforce Study describes the demographic and school nursing practice patterns among self-reported public school nurses and the number and full-time equivalent (FTE) positions of all school nurses in the United States. Using a random sample stratified by public/private, region, school level, and urban/rural status from two large national data sets, we report on weighted survey responses of 1,062 public schools. Additional questions were administered to estimate the school nurse population and FTEs. Findings reported illustrate differences by strata in public school nurse demographics, practice patterns, and nursing activities and tasks. We estimate approximately 132,300 self-identified practicing public and private school nurses and 95,800 FTEs of school nurses in the United States. Research, policy, and school nursing practice implications are discussed.

This study explored relationships between school nurses' diabetes-related attitudes, self-efficacy in diabetes management and education, and care practices. One-hundred fourteen school nurses who have taken care of students with type 1 diabetes in public schools comprised this descriptive study sample. Participants completed online surveys. School nurses' diabetes-related attitudes were not related to their self-efficacy in diabetes education, but nurses' attitudes towards the psychosocial impact of diabetes were significantly related to their self-efficacy in diabetes management, and the number of students with diabetes was a significant contributor to this relationship. Nurses' full-time status and the type of school they worked in were significantly related to their self-efficacy in providing diabetes education. School nurses' positive attitudes about providing care for students with diabetes were related to having a higher level of self-efficacy in providing diabetes management. Based on the findings, recommendations are made for health consolidated schools and full-time school nurses. [ABSTRACT FROM AUTHOR]

The extent to which observed disparities in access to primary pediatric care are mirrored in student access to school nursing services is unknown. Using school employment records, we linked 1,346 nurses to school districts serving 1,141,495 students in Washington state. The percentage of students who are Black is negatively associated with the student-to-nurse ratio, while the percentage of students eligible for free-or-reduced-price lunch is positively associated, and relative to urban districts, rural districts have higher student-to-nurse ratios. Disparities in access to school nursing services mirror access gaps for pediatric care along socioeconomic status and geography. The increased number of nurses working in districts with more racial/ethnic minority students may play a protective role and ameliorate access gaps observed in pediatric primary care. States can likely use existing employment and licensing data to understand where school nurses work and therefore guide resource allocation decisions. [ABSTRACT FROM AUTHOR]

The article discusses the Implicit Bias Clinical Teaching Program, developed using the equityXdesign framework, which aims to prepare future nurses to interrupt bias in clinical settings and improve health equity by incorporating diverse voices and perspectives into nursing curricula.

Inadequate sleep occurs in 25% of our nation's children; poor sleep is associated with physical, cognitive, and social consequences. Developing good sleep hygiene in middle childhood is important, because habits typically extend to adolescence and adulthood; yet, there has been little research on sleep interventions for school-age children. The purpose of this study was to determine the feasibility of a developmentally tailored, motivation-based intervention (MBI) focused on improving sleep behaviors in school-age children aged 8-11. Nine parent-child dyads participated in an 8-week protocol utilizing MBI and comparisons of objective (actigraphy) and subjective (sleep diaries) data. Results suggest that parent and children are able to identify a target behavior to change and complete the protocol. Further, preliminary evidence indicates that sleep patterns change using MBI. Future research will be directed toward comparative effectiveness testing and exploring ways in which it can be adapted and incorporated into school nursing practice.

Sleep has been linked to a host of physical, behavioral, and emotional outcomes, and research has documented that youth across the globe are experiencing inadequate sleep. Despite this knowledge, however, very little research has been conducted on school-age children; much of the extant research has focused on infants, toddlers, preschoolers, adolescents, and adults. School-age children exhibit increasing independence around health-related behaviors, which provide health professionals the opportunity to educate and promote healthy sleep behaviors. This commentary extends previous research reviews by identifying the current gaps in sleep research, highlighting future directions needed in sleep research, and explaining why school nurses are best suited to address this growing public health issue.

Recent criticism has focused on the validity of instruments used in research with immigrant populations. Conventional instrument development or validation techniques may not be adequate to determine whether an instrument is appropriate for use with populations who differ from those with whom the instrument was originally developed. This article discusses the value of using focus group methodology to develop instruments for use with immigrant populations using the example of an intergenerational conflict tool for multigenerational Chinese immigrant families. Involving community members through focus groups is an important component of instrument development that is often neglected by researchers. This process was critical to developing a culturally appropriate instrument that accurately reflected the community's life experiences. Strategies for conducting meaningful and successful focus groups with Chinese immigrants are provided. Advantages and disadvantages of using focus groups are also discussed. Keywords: focus groups; immigrants; cultural relevancy; research methods

Background: Poor communication is a leading cause of errors in health care. Structured interprofessional bedside rounds are a promising model to improve communication. Purpose: The aim of the study was to test if an intervention to improve communication and coordination in an inpatient heart failure care unit would result in lasting change. Methodology/Approach: The relational coordination (RC) survey was administered to seven workgroups (i.e., nurses, physicians) at baseline (2015) and three subsequent years following the intervention (team training, leadership development workshops, and structured interprofessional bedside round implementation). Descriptive analysis and mixed-effects models were used to assess the impact of the intervention on improving RC. Results: During the study period (2015--2018), 344 participants completed the survey for an overall response rate of 53.5%(n = 643). Postintervention, the RC index significantly increased from3.79 to 4.08 (p < .001) and remained significantly higher over 2 years, with an RC index of 4.12 and 4.04, respectively (p < .001). The range of RC scores between and within workgroups narrowed over time, with nonrotating workgroups showing the most improvements. Conclusion: Findings indicate that positive changes as a result of the intervention have been sustained, despite high rates of turnover among all workgroups. Notably, positive change in RC was found to be more pronounced for nonrotating workgroups compared to teammembers who rotate within the hospital (i.e., pharmacists who rotate to other units every month). Practice Implications: This intervention holds promise for teams seeking best practicemodels of"high-reliability"care organization and delivery. Sustained changes fromthis intervention represent an important area of future practice-based research. [ABSTRACT FROM AUTHOR]