Improving School Nursing Practice in South Carolina through Continuing Education

Article excerpt

School nurses represent the primary -- and in some cases the sole -- health care provider in school districts. In South Carolina, physicians are available only as voluntary advisors and consultants, and school districts often lack social workers to make referrals. School nurses often provide direct health care for school-age children. To meet the health needs of all children, school nurses need a range of knowledge and skills to provide essential services. The degree to which school nurses meet this challenge depends on availability of quality educational programs. A statewide continuing education program was initiated to enhance the program management, physical, psychosocial, and environmental health dimensions of the school nurse's practice.

Findings on the effect of the continuing education program on role performance and intrinsic and extrinsic job satisfaction of school nurses participating in the program are reported extensively elsewhere.|1~ Participants indicated a significant positive linear trend in intrinsic job satisfaction at program completion and at nine months after project completion; an increase in extrinsic satisfaction at program completion, followed by a decrease in level of extrinsic satisfaction nine months after completion; a decrease over time in the magnitude of the relationship between role performance and extrinsic satisfaction; and maintenance of a consistent positive relationship between role performance and intrinsic satisfaction 18 months after entering the program.|1~

BACKGROUND

Providing health services to schoolchildren represents a benchmark of school nursing practice.|2-4~ The American Academy of Pediatrics recommends a comprehensive health assessment, in addition to screenings, for thorough identification of health problems.|5-7~ Health problems of school-age youth include social, emotional, behavioral, and technological issues. Many problems are preventable through direct and indirect contributions of school programs and school nurses knowledgeable in disease prevention, health promotion, and health protection.|8~ Most health problems of schoolchildren can be identified and managed by school nurses.|9~ Solutions proposed to address health problems of school-age youth include a "nationwide program of continuing education for school nurses to expand and update their health promotion, disease prevention and health protection knowledge and skills."|8~ Such effort can reduce the incidence of abuse and neglect, sexually transmitted diseases, pregnancy, substance abuse, violence, and lifestyle-related illnesses among the school-age population.|10,11~

In 1985, risk-taking behaviors of South Carolina adolescents were increasing at an alarming rate. Adolescent sexual behavior accounted for 12% of low birth-weight babies,|12~ 15% of reported cases of syphilis, and 24-70 of gonorrhea cases.|13~ Family violence and abuse rose to more than 6,000 confirmed cases.|14~ Unhealthy lifestyle behaviors and lack of preventive care became more evident with hypertension detected in 10% of teenagers.|15~ Further, the increasing number of uninsured children ineligible for Medicaid needed health services. Such threats to the health of the school-age population underscored the need for school-based interventions.

PROGRAM DEVELOPMENT

In response, a continuing education program was developed for school nurses, the health care professionals who could best address the pressing need for school-based interventions. The program assisted school nurses in developing their roles within the framework of the Standards of School Nursing Practice.|16~ These standards facilitate the purpose of school nursing "to enhance the educational process by the modification or removal of health-related barriers to learning, and by promotion of an optimal level of wellness."|16~

School nurses historically face a poorly articulated set of role expectations.|17-19~ The Standards for School Nursing Practice defined the school nurse role and reduced ambiguity. …