Institutional Assessment Nursing 7250 Auburn University Kayleigh Hester

Institutional Assessment Nursing 7250 Auburn University Kayleigh Hester Nikita Patel Alison Pruitt Lauren Smith Kecia Williams

SCHOOL NURSING �Definition �School nursing is a specialized practice of professional nursing that advances the well-being, academic success and life-long achievement and health of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety including a healthy environment; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self advocacy, and learning (NASN, 2010).

SCHOOL NURSE ROLE �Provides direct health care to students and staff �Provides leadership for the provision of health services �Provides screenings and referrals for health conditions �Promotes a healthy school environment �Promotes health education �Serves in a leadership role for health policies and programs �Serves as a liaison between school personnel, family, community and health care providers

DEMOGRAPHIC CHANGE �Asthma �Attention Deficit Disorder �Anaphylaxis �Cerebral Palsy �Colostomy �Cystic Fibrosis �Diabetes �Gastrostomy Tube Feedings �Pacemaker �Seizures �Sickle Cell Anemia �Tracheotomy

NURSE – STUDENT RATIO �Current �assignment includes more than one school �Ideal � 1: 750 (nurse to student)

Background AUBURN CITY SCHOOLS �Auburn City Schools � Elementary Schools � Auburn Early Education Center (K-2 nd grades) � Cary Woods Elementary (K-2 nd grades) � Dean Road Elementary (K-2 nd grades) � Richland Road Elementary (K-2 nd grades) � Ogletree Elementary (3 rd-5 th grades) � Pick Elementary (3 rd-5 th grades) � Wrights Mill Road Elementary (3 rd-5 th grades) � Yarbrough Elementary (3 rd-5 th grades � Middle School � Drake Middle (6 th-7 th grades) � Junior High School � Auburn Junior High (8 th-9 th grades) � High School � Auburn High (10 th-12 th grades)

Background OXFORD CITY SCHOOLS �Oxford City Schools �Elementary Schools � Coldwater Elementary (K-4 th grades) � Dearmanville Elementary (K-4 th grades) � Oxford Elementary (K-4 th grades) � CE Hanna Elementary (5 th-6 th grades) �Middle School � Oxford Middle School (7 th-8 th grades) �Junior High � Oxford Freshman Academy (9 th grade) �High School � Oxford High School (10 th-12 th grades)

Background LAGRANGE SCHOOLS � La. Grange City Schools � Elementary Schools � � � Callaway Elementary Long Cane Elementary Hillcrest Elementary Franklin Forest Elementary Ethel Kight Magnet School Berta Weathersbee Elementary � Middle Schools � � � Callaway Middle Gardner Newman Long Cane Middle � High Schools � Troup County Comprehensive High � La. Grange High � Callaway High � Private Schools � La. Grange Academy � Lafayette Christian Academy

Proposed Change AUBURN CITY SCHOOLS • Short-term goals • Part-time registered nurse assigned to the pairing of each elementary schools (K-2 nd, 3 rd-5 th) • Full-time registered nurse assigned to middle school • Full-time registered nurse assigned to junior high school • Full-time registered nurse assigned to high school • Long-term goal • Full-time registered nurse within each school of Auburn City

Proposed Change OXFORD CITY SCHOOLS �Short-term goals �Full time float registered nurse for freshman academy and high school �Registered nurse to ride bus in morning and afternoon for students with higher risk health problems �Long term goals �Full time registered nurse to student ratio to decrease t 0 at least 1: 750 per school.

Proposed Change LAGRANGE SCHOOLS �Short-term goals �Two full-time registered nurses assigned to the Elementary schools �Full-time registered nurse assigned to the middle schools �Full-time registered nurse assigned to the high schools �Long-term goals �Full time registered nurses within each of the schools

VESTED INTERESTS �Drivers � Superintendents �Team Members of Strategic Planning Committee �Resistors �Financial Advisor �Team Members of Strategic Planning Committee �Stakeholders �Staff �Students �Parents �Community Representatives

Non-Human Resources �Time �For research �To evaluate needs �To implement changes �Questionnaires �To assess the need for change �To evaluate improvement after change is implemented

CHANGE THEORIES �Lewin’s 1951 Change Model �Unfreezing � Examine status quo � Increase driving forces for change �Moving � Take action � Make changes � Involve people �Refreezing � Make changes permanent � Establish new way of things � Reward desired outcomes

CHANGE THEORIES �Lippitt’s Seven Phases of Planned Change � Phase 1 � Phase 2 � Phase 3 � Phase 4 � Phase 5 � Phase 6 � Phase 7

EVALUATION THEORIES �Goals of this Institutional Assessment �Nurse-to-student ratio �Holistic care for the student �Wellness Promotion �Evaluation Theories �Questionnaires � CHASE (Child Health Assessment at School Entry) � HBSC (Health Behavior in School-aged Children) � Parents’/Guardians’ Perceptions

CHASE � 10 primary schools in London �Parent questionnaire � Consent form, informational meeting about study, and mailed with pre-stamped return envelope �School Nurse questionnaire �High validity and reliability with 0. 8 �Accepted by parents and school nurses �Feasible to implement �Edmunds, Garratt, Haines, and Blair (2005)

HBSC �Purpose of study �Compare outcomes of health dialogue with school nurse among overweight and normal weight students �Student answered questionnaire �Sealed envelope preventing school staff from access to responses �Voluntary and anonymous � 11 year old boys perceived more positive effects �Health dialogues in place of screenings �High face validity �Borup and Holstein (2010)

Parents’/Guardians Perceptions �Purpose of study �Identify perceptions and beliefs about school health services �Parent completed questionnaire �Mailed questionnaires with self-addressed and stamped return envelopes, human subject approval obtained, voluntary, and confidential � 78% had a school nurse � 86. 3% perceived full-time school nurses as important �Majority were willing to pay more taxes to have full-time school health personnel �Satisfactory validity and reliability with 0. 77 �Kirchofer, Telljohann, Price, Dake, and Ritchie (2007)

Institutional Assessment Evaluation Theory �Questionnaire �Parent, student, and school nurse �Assess parent perception, student benefit, and nurse productivity �Outcomes expected �Appropriate nurse to student ratio �More healthy students providing improved academic performance �Less medication or health errors with school nurse �Higher parent satisfaction with school health services and their child’s overall health

NURSING IMPLICATIONS �Wellness Promotion � immunization review � teaching interventions � injury prevention �Health Condition Management � administer medicines � manage asthma � address anaphylaxis � monitor diabetes � implement feedings � suction tracheotomy � evaluate crises ( seizures, cystic fibrosis, sickle cell anemia) �Improved Academic Performance � decreased absenteeism � increased attendance

CONCLUSIONS �What did we learn from our assessment? � School nursing has evolved greatly from when it was first introduced. � School nurses play a critical role in educating parents, faculty, and students in ways to prevent illness and promote health. � A shortage of school nurses has led to the disproportionate nurse to student ratio, which was seen in all three of the school districts. � For implementation to take place, the need for school nurses must be seen as a priority to school faculty, teachers, and the community.

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