With the expansion of CAI therapy use in children, it is imperative that school nurses are knowledgeable and equipped to assist children in the school setting. However, minimal information on if and how school nurses should administer these therapies is readily available. In addition to the lack of procedural guidance for school nurses, there is also limited data about nurses’ perception and knowledge of CAI and this data only includes nurses practicing in areas other than school nursing. In a systematic review that included 15 studies (n=5162) about nurses’ knowledge and use of CAI therapies, 77.4% believed they needed more training, 80% expressed deterrents to using CAI in various work settings, and less than 25% reported discussing CAI with their patients (Chang & Chang, 2015). Similarly, in a descriptive study (n=335), researchers found that less than a third of nurses inquired about CAI use in their patients citing that they did not have the knowledge base to do so, lacked time to ask, or felt CAI was not an important part of the treatment plan (Jong, Lundqvist, & Jong, 2015). There are no studies focusing on CAI therapies and school nurses, therefore, the purpose of this study was to assess school nurses’ perception and knowledge of CAI and their understanding of the necessity and legality of CAI use in their school districts.
Methods: This nonexperimental, descriptive study was conducted using a researcher-developed instrument. The final survey received approval by the Western Kentucky University Institutional Review Board prior to administration. A comprehensive literature review was performed in order to create the 4-page, 28-question instrument. Fifteen Likert-type scale questions assessed perceptions, training, and comfort in administering CAI therapies to students. Three multiple choice items assessed knowledge of CAI therapies and 10 close-ended questions were included to obtain background and demographic information. A cross-sectional convenience sample of members of state School Nurses Associations in four states completed the survey. The survey was delivered electronically via Qualtrics, an online survey software, or at the State School Nurses Association Annual conference. A total of 290 school nurses (30.5% response rate) participated in the study. Data were analyzed using IBM SPSS Statistics Version 24. Responses were described using frequencies, means, and standard deviations. Relationships between independent and dependent variables were determined using Chi-square. The significance level was set at p < .05.
Results: The majority of participants were female (99.3%), between the ages of 50 and 59 (46.2%), and Caucasian (93.5%). Most school nurses were employed full-time (89.9%) and nearly half of them practiced in suburban schools (45.4%). In addition, the respondents held state (63%), national (11.2%) or state and national (25.9%) certifications. A third of the participating school nurses did not have the school nursing certification.
Three questions were developed to assess the nurse’s knowledge of CAI terminology. Most selected the correct definition of alternative medicine but less than 50% understood the meaning of complementary and integrative medicine. The majority of school nurses believed that music therapy (55%), art therapy (55.7%), meditation (54.7%), and yoga (51%) were supported by research and evidence based practice.
Few of the participants reported seeing children use these therapies in their practice. Less than 25% of school nurses felt comfortable in administering CAI therapies such as music and art therapy, meditation, prayer and spiritual intervention, yoga, or aromatherapy. Interestingly, 100% of certified school nurses and 63% of non-certified school nurses felt that these therapies have a role in their practice and a majority of participants (82.4%) believed that CAI education is needed for school nurses.
Participants thought that students under age 12 (65%) and adolescents (71%) have the right to use these therapies at school. However, only 19% of respondents felt comfortable assessing students and few (12%) believed they were knowledgeable about CAI therapies. Nearly 70% of respondents were unaware of their state board of nursing policy or school district policy on the use of CAI in their scope of practice.
Discussion/Conclusion: School nurses in this study believe that students should be able to use CAI therapies at school however, most were not comfortable with assessing for use and administering these therapies to their student population. Furthermore, a majority did not know if administration was even within their scope of practice. The school nurse may be one of the first professionals that parents and children look to for guidance in administration of CAI therapies therefore it behooves the school nurse to be ready. Position statements for education of pediatric nurses and implementation of CAI therapies have been largely overlooked in the U.S. Over 20 years ago, Cleveland and Biester (1995) called for pediatric nurses to be educated in CAI therapies, conduct research in their practices, and advocate for inclusion of these therapies in health care plans. A decade later, The Society of Pediatric Nurses printed a Position Statement with recommendations for the use of CAI in the care of children (Asher, 2007). This document called once more for education of health care providers, promotion of research, and education of children and their families. Most recently, in an editorial in the Journal of Pediatric Nursing, another plea for more attention by providers was made due to the prevalence of use of CAI therapies in pediatric patients (Betz, 2018).
In addition to education in delivering these therapies and conduct of research, policy advocacy is also paramount. Lack of guidelines or position statements should be addressed and be readily available to the school nurse. Position Statements in addition to the State Board of Nursing Regulations on scope of practice help clarify the role of the school nurse in delivering CAI therapy (North Carolina Board of Nursing, 2016). In addition, policies created by State Boards of Education (Illinois State Board of Education, 2018) help clarify the safe administration of medication. The 2017 National School Nurses Association Position Statement on medication administration recommends that school policies reflect those of local and state governments (National Association of School Nurses [NASN], 2017). Evidence indicates that use of CAI therapies by children is increasing each year but pediatric nurses are slow in reacting to the calls for preparation. It is imperative that school nurses become educated on the safe administration of these therapies and that they advocate the use of CAI therapies for their students. Most importantly, school nurses should have clear policies on the administration of CAI therapies and when lacking, they should be instrumental in petitioning the appropriate agencies for guidance.