Academic journal article Journal of School Health

School Nurses' Perceptions of and Experiences with Head Lice

Academic journal article Journal of School Health

School Nurses' Perceptions of and Experiences with Head Lice

Article excerpt

As the 21st century approaches, one of the most common public health problems facing families with young children is head lice (Pediculus humanus capitis). Head lice affects more than 10 million Americans annually, and most are children 5 to 12 years of age.[1] Almost one in four elementary students was infested last year.[2] Lice infestations are common in crowded environments like day care centers and schools and usually peak between August and November.

Head lice are wingless insects that are obligate parasites of humans. The life span of a female louse is about 30 days, during which she lays up to 5 to 10 nits (eggs) per day.[3] Each nit is attached with a glue-like, water-proof substance to hairs one millimeter from the scalp. Within 10 days, the nits open and release the nymph, an immature louse.[4] The adult nymph reaches the mature reproductive stage within 8 to 9 days.[5] The infection cycle can then start over again.

Transmission of head lice occurs through direct physical contact with an infested individual or indirectly through shared personal effects such as hats, combs, and towels.[6] Head lice do not jump or fly nor are they transmitted by pets.[7] Parents are often embarrassed when informed that their children have head lice because of the widespread misperception that head lice infestations result from unwashed dirty heads.[8]

Treatment of lice infestations include the following: 1) an agent, often an insecticide shampoo is used to kill the lice; 2) fomite control is required to reduce the risk of reinfestation, including cleaning hats, combs, and clothing; and 3) nit removal.[9] The lice cannot live more than a couple of days if not on a human head.

The primary person for therapy and parental information during lice infestations is usually the school nurse,[10] A comprehensive review of the literature failed to find any studies that examined experiences and perceptions of school nurses regarding control of head lice. Thus, this study examined the following questions: 1) How do school nurses deal with children with head lice? 2) What products do school nurses recommend for treating head lice infestations? 3) Do school nurses perceive it difficult to eliminate a school population of head lice? 4) What is the perceived self-efficacy of school nurses in dealing with head lice? 5) Where have school nurses received most of their information on head lice?



A simple random sample of 500 school nurses, members of the School Nurse Section of the American School Health Association, were selected as potential respondents. If a survey was returned because of an incorrect address, there was no plan to randomly select other nurses to replace undeliverables.


A 47-item survey instrument was developed for the study. Except for three items, the survey items were closed-format design. Respondents were requested to either select from a series of potential choices to an item or to circle how much they agreed or disagreed with items (e.g., strongly agree = 5 to strongly disagree = 1). The final six questions were demographic items, including age, gender, school setting, educational background, years of experience as a school nurse, and state in which they work.

The study employed Bandura's self-efficacy model to investigate school nurses perceived self-efficacy for eliminating head lice infestations. Bandura's self-efficacy model is comprised of three components: 1) Efficacy-Expectations, which refers to one's belief regarding the ability to perform certain behaviors to produce a desired outcome; 2) Outcome Expectations, which refers to one's belief that performing certain behaviors will result in a specific outcome; and 3) Outcome Value, which denotes the degree of importance one ascribes to the outcome. Five items comprised the efficacy expectations subscale, and the possible range of scores was 5 to 25. …

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