The Journal of School Nursing

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

This study examined associations between four indicators of social determinants of health (SDOH; parent education, poverty, material hardships, and child health problems), chronic school absence, and teachers’ ratings of parents’ engagement in their children's education. Surveys were collected from 304 parents and 26 teachers from eight Baltimore City Public Schools. Results revealed that teachers’ ratings of parent engagement were consistently lower among families experiencing adverse SDOH and/or whose children were chronically absent; however, there was no significant relationship between teachers’ ratings of parent engagement and child health problems. Additionally, chronic absence partially mediated the relationship between three SDOH indicators (total material hardships, parent education level, and child health problems) and teacher-rated parent engagement. Poverty was excluded from mediation analysis due to evidence of multicollinearity suppressive effects. Addressing the SDOH assessed in this study may be an effective strategy to reduce chronic absence, promote parent engagement, and foster equity in education.

The purpose of this quasi-experimental study was to evaluate the effects of two farm-to-school programs, specifically the Field-to-Fork Multi-visit Program (N  =  264) and the Field-to-Fork After-school Club (N  =  56), on nutritional outcomes of elementary school students (third to fifth grade) from urban, diverse, and lower-income communities. Data were collected via self-report surveys measuring: (a) knowledge of recommendations for daily fruit and vegetable intake; (b) fruit and vegetable consumption; (c) knowledge of cooking a healthy recipe using vegetables; and (d) desire for farm fresh foods at school. Statistical analyses included McNemar’s and Wilcoxon signed rank tests. The proportion of students knowing how to cook a vegetable rich recipe increased with both programs (Multi-visit Program p < .001; After-school Club p  =  .002). Vegetable consumption increased with the After-school Club (p  =  .002). Farm-to-school programming can increase knowledge of cooking vegetable rich recipes and vegetable intake among elementary school students from diverse, urban, and lower-income communities.

The purpose of this study was to determine the amount of time elementary and middle-school students spend away from the classroom and clinic time required to administer vaccines in school-located vaccination (SLV) clinics. We conducted a time study and estimated average time away from class and time to administer vaccine by health department (HD), student grade level, vaccine type, and vaccination process for SLV clinics during the 2012–2013 school year. Average time away from classroom was 10 min (sample: 688 students, 15 schools, three participating HD districts). Overall, time to administer intranasally administered influenza vaccine was nearly half the time to administer injected vaccine (52.5 vs. 101.7 s) (sample: 330 students, two HDs). SLV administration requires minimal time outside of class for elementary and middle-school students. SLV clinics may be an efficient way to administer catch-up vaccines to children who missed routine vaccinations during the coronavirus disease-2019 pandemic.

Youth Risk Behavior Survey 2011–2017 data were examined for associations among high school population subsets who self-reported suicide risk behaviors and experiences with bullying. High-school students who reported suicidal risk behaviors were 4.64 times more likely to have experienced bullying electronically. Ninth grade and female students were more likely than others to experience suicide risk behaviors and bullying. At the interpersonal level, school nurses are able to identify students who are experiencing bullying and who exhibit suicide risk behaviors. At the systems level, bullying prevention efforts should target all students. School nurses, administrators, policy makers, and health providers should consider data-driven recommendations in bullying prevention programs.

The study purpose was to examine whether adolescents who participated in organized physical activity (PA) programs differed from nonparticipants in motivation, social support, and self-efficacy related to PA; PA (min/hr); and sedentary screen time behavior. Thirty-nine 5th–7th grade adolescents participated in organized PA programs; 41 did not. Approximately 56.3% were Black, and 52.5% had annual family incomes <$20,000. Compared to nonparticipants, those who participated reported significantly higher social support (M = 2.32 vs. 3.13, p < .001) and fewer hours watching television or movies on a usual weekend day (M = 2.49 vs. 1.59, p = .016); and had higher accelerometer-measured vigorous PA (M = 0.58 vs. 1.04, p = .009) and moderate-to-vigorous PA (M = 2.48 vs. 3.45, p = .035). Involving adolescents in organized PA programs may be important for improving their moderate-to-vigorous PA, vigorous PA, and related psychosocial factors, as well as reducing sedentary screen time behavior.

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.

Chronic absenteeism is associated with poor health and educational outcomes. School nurses have great potential to address the health and educational needs that contribute to absenteeism. Through qualitative analysis of interviews with school nurses, we characterize their current role in reducing absenteeism and identify barriers 3 that limit their capacity to meet this goal, organized by the Framework for 21st Century School Nursing Practice. Interviewees (n = 23) identified actions perceived to reduce absenteeism aligned with domains of care coordination, leadership, quality improvement, and community and public health. Barriers perceived to limit the capacity of school nurses to address absenteeism were identified within these domains and ranged from student- and family-level to federal-level barriers. Specific healthcare system-level barriers included insufficient communication with community-based healthcare teams and the need for coordinated approaches across health and education sectors to address absenteeism. Strategic opportunities exist to address barriers to comprehensive school nursing practice and reduce absenteeism.

Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses’ obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles.

For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.

Access to menstrual products is important to support adolescent health. Advocacy to increase access to menstrual products in schools is growing; however, ideal access requires policies that will require schools to support the menstrual health of menstruating students. We conducted a legislative review on the existence and status of state legislation related to the provision of menstrual products in US schools and categorized by state's political control (political party affiliation of governors and state legislature). Of 50 states and 6 territories, 21 had legislation to support menstrual products in schools, 7 had bills pending, 10 had bills failed, and 18 states had no policies introduced in the state legislature. States with Democrat control have significantly more menstrual product state laws compared to states with Republican control [z  =  2.54, p  =  0.01]. There is a need, especially in Republican states, to accelerate efforts to pass laws that will support menstrual product access in schools.