Health Service Applications

Perceptions of School Nursing by School Districts Eva Miller, Joyce W. Hopp

ecently, directors of the school nurse prepara- R tion program at Loma Linda University sur- veyed five school districts in the Inland Empire area of southern California to identify current practice competencies and to ascertain the need for such a pro- gram. In California, the state’s Commission on Teacher Credentialing mandates such surveys for all school nurse preparation programs that offer the Health Services Credential.

The survey results, in addition to serving as a guide for curriculum revision within the university, also re- vealed items of interest to school administrators, teachers, and school nurses.

BAC KG ROU N D The Teacher Preparation and Licensing Law of

1970, known in California as the Ryan Act, renamed the nursing credential the “Health Services Creden- tial: School Nurse.” The law requires applicants to attend an approved program equal to a fifth academic year (not less than 24 semester units).

Professional preparation programs must include, but are not limited to, competencies in health appraisal (health status, vision, hearing, dental health, and nutritional status), prevention and con- trol of communicable diseases, emergency care, child abuse, drug abuse, health counseling, needs of exceptional children, health resources, professional and legal requirements, human relations skills, organization, administration and legal aspects of school health, organization and utilization of instruc- tional materials, facilities, and equipment, budgeting and accounting, action research, and environmental health and safety.

Applicants are eligible for a preliminary health credential after they successfully complete an accredited program. The professional credential is issued after two years of professional school nurse experience.

METHOD The school nurse competencies identified in The

School Nurse Services Program, Part Z, ’ a publica- Eva Miller, R N , MS, Associate Professor, Community Health Nursing, and Coordinator, School Nurse Preparation, School of Nursinx: and Joyce W. Hopp, PhD, M P H , R N , F A S H A . Profes- sor, School of Public Health, and Dean, School of Allied Health Prc!fessions, Lorna Linda University, Loma Linda. C A 92350. This urricle was submitted September 30, 1987, and revised and act~pted .for publication February 15, 1988.

tion of the California School Nurse Organization (CSNO), served as the standard in developing the survey instrument. The school nurse advisory com- mittee at Loma Linda University made additional suggestions. Six school districts were chosen as a representative sample.

The survey instrument included a list of clinical skills which the participants were to prioritize, demo- graphic data on the respondents and their schools, and perceptions of the availability of a credentialed school nurse. Questionnaires were distributed through school district offices. Targeted respondents were principals, parents, teachers, nurses, school staff (secretaries, janitors, and teachers’ aides), school psychologists, audiometrists, and physical therapists.

RESULTS One hundred seventy-three surveys were returned,

reaching the preset goal of a 60% return rate. Two school districts that demonstrated the greatest mis- perceptions about the availability of a credentialed school nurse were districts which did not fit the usual pattern. One district assigned caseloads of special education students to credentialed school nurses, while the other district used health technicians.

Respondents rated school nurses as receiving lower salaries than actually was the case.

For clinical skills, the CSNO’s listing of essential skills was provided and participants checked the skills they felt were necessary. Results are presented in Figure 1, cumulatively graphed by category.

Figure 1 Essential Health Assessment Skills

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Figure 2 Desirable Health Instruction Activities

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Respondents' perceptions varied widely. Princi- pals gave screening the highest priority, while teachers, parents, staff, and others gave first aid and emergency care the highest priority. Nurses named prevention and control of communicable disease. Skills that all participants named within two points of each other included care of ill students, physical exams, and assistance with driver training programs. Skills in which four or more participating categories of respondents agreed on priority included first aid and emergency care, care of ill students, and physical examination.

Health instruction activities deemed desirable for school nurse practice are reported in Figure 2. Princi- pals, staff, and others agreed school nurses should be planning and conducting staff development pro- grams. However, nurses saw their first priority equal- ly in classroom instruction and parent health educa- tion programs. The widest ranges in priorities were in classroom instruction, team teaching health topics with teachers, and parent health education programs.

Figure 3 contains the respondents' perceptions of the role of school nurses in health counseling. The CSNO's listed categories included planned and spon- taneous individual and group health counseling. Of these, physical health problems virtually received a 100% ranking from all respondents. However, a wide discrepancy existed for counseling on emotional health problems; 100% of the nurses included this skill as important, while most principals, teachers, parents, staff, and others felt this was not an essen- tial part of the school nurse's work.

Perceptions of the effectiveness of credentialed school nurse practitioners (CSN-P) also were com- pared, and these are at variance with reality, since some respondents' knowledge of the presence of a CSN-P was inaccurate. Confusion regarding the role of the CSN-P is apparent in all school districts. Nurses, parents, and staff perceived the CSN-P would be much more effective than the credentialed school nurse and could perform the school physical examinations at less cost and greater convenience. Principals, teachers, and others did not perceive any great benefit.

Participants emphasized the following skills of the credentialed school nurse: more thorough eye

exams (other), goqd personal interrelationship skills with students and teachers, time management skills (nurse), communication (nurse), public speaking skills (nurse), group teaching skills (nurse), physical assessment skills (nurse), counseling strategies for building parenting skills for child's personal hygiene and health habits (nurse), disaster preparedness (nurse), teaching stress management (nurse), teach- ing weight management (teacher), cardiopulmonary resuscitation, (nurse) and inservice of staff in CPR and other health-related matters (principal), health education of parents and community (principal), and be bilingual (principal).

Other suggestions were: more time at school site (parents and teachers), school nurse needs assistance for completing required tasks (other), nurse available at site three hours each day (teacher), a dynamic per- sonality (teacher), help with parents of learning handicapped students (teacher), cases of child abuse referred to (teacher), wish we had school nurses at each school site (teacher), do not like school nurse doing complete physicals on students whose parents do not want to take them to a physician as this ties her up so she is not available to majority of student body (teacher), most school nurses do not have time for health instruction; would be nice if they did (parent), being a nurse practitioner would be very helpful (parent), and more time (nurse), and mystical and magical powers (nurse).

CONCLUSIONS AND RECOMMENDATIONS The results of the survey of five school districts

within a 30-mile radius of Lorna Linda University (southern California between San Bernardino and Riverside, Calif.) affirmed that school nurse prepara- tion programs should include and emphasize that:

1) School nurses be prepared to articulate their competencies and skills in the school setting;

2) The public needs to be educated about the var- ious levels of nursing preparation, especially since different terms are used for the persons providing nursing service in schools, such as health technicians, credentialed school nurses, and school nurse practi- tioners; and

Figure 3 Perceptions of School Nurse's

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3) Emphasis in school nurse preparation should address setting priorities within the school systems, using available resources. Program planning skills - assessment, goal setting, marshalling of resources, implementation, and evaluation of outcomes - need to be a part of the preparation.

While the survey results pertain particularly to Lorna Linda University, there is pertinent informa- tion for other school nurse preparation programs.

However, one major question needs to be addressed by the school nurse profession: Who determines what is appropriate school nursing practice?

References 1. California School Nurses Organization: The School Nurse

Services Program, Part 1, 3rd ed. Sacramento, California School Nurses Organization, 1983.

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School Nurses' Conference - The Health and Education Council will sponsor "School Nursing '88: Preparing for the 21st Century,'' August 11-12 in Baltimore. Registration is $156 and 12 contact hours will be available. The conference is being cosponsored by the March of Dimes and the Maryland State School Health Council. For information, contact: The Health and Education Council, Inc., 7201 Rossville Hlvd., Baltimore, MD 21237, 301/686-3610.

WE'RE FIGHTING FOR W R LIFE

American H e a r t Association

Journal of School Health May 1988, Vol. 58, No. 5 199