According to the National Association of School Nurses (NASN), only 45 percent of the U.S. public schools have a full-time on-site nurse. Fifty-six million school children in Texas public and private schools are served by school nurses according to National Center for Education Statistics (Musu & Fenster, 2018). Some school nurses are working with a 600:1 ratio. School children in Texas need hearing, vision, scoliosis and Acanthosis Nigricans (AN) screening within the first one hundred twenty days of school. School nurses face the challenge of completing all the screens within the first 120 days but also lack certified screeners to perform a thorough and competent exam to promote the health of children and adolescents in Texas schools. During vision/hearing and scoliosis screenings of 1st, 3rd, 5th, and 7th graders in public and private schools, certified individuals assess children for the AN marker, a skin condition that signals high insulin levels. Children who are positively identified with the marker undergo additional assessments of body mass index (BMI), BMI percentile, and blood pressure. Referrals are issued to the parents of these children, alerting each parent of their child's risk factors and encouraging further evaluation from a health professional. Becoming aware of and understanding what the risk factors suggest can help stimulate the changes necessary to prevent or delay future health problems for children at risk of developing Type 2 Diabetes and other conditions.
Telehealth is a practical option for both consumers and nurses because of the global expansion of the Internet and network capacity. Consequently, many underserved populations and rural communities are afforded nursing care services when delivered via telehealth methods. A gap in services that is growing as school funding cuts continue. School based health services function as a silent healthcare system for community and public health. With fewer school nurses to cover greater number of students/schools, U.S. school children are becoming an underserved population. Telehealth services have been successfully implemented in school systems to manage common conditions of the school age child ranging from asthma to behavioral disorders. Telehealth services were found to be cost effective while enhance patient safety, quality of care, and to have achieved high acceptance by parents, students, and school officials. Telehealth knowledge, skills and competencies is a critical component needed in the educational curricula of both pre-licensure and graduate nursing students (Lister, 2018). School health screenings are an exemplar of nursing preventive and promotive health nursing activities for baccalaureate (BSN) and graduate (MSN) pediatric courses, as well as community service learning projects. The purpose of this report is to describe: 1) a school of nursing’s collaboration with a state supported school district to meet state mandated health screenings for 27 schools and 7,000 school children; 2) to certify nursing students in hearing, vision, scoliosis, and Acanthosis Nigricans screening; and 3) a telehealth school screening protocol for faculty and student screeners.
Methods:
Collaboration: The school of nursing (SON) reached out to a school district to consider working together with the school nurses to meet state mandated student screenings. Some school nurses were not certified screeners. So, another part of the collaboration between the SON and the school district nurses was to provide a school nurse refresher course (School Nurse Boot Camp) that included certifications as well as medication updates, tracheostomy care, and emergency procedures using the SON facilities including the simulation lab. Phase I – BSN and MSN nursing students were certified as school health screeners (hearing, vision, scoliosis, and Acanthosis Nigricans) in accordance to the Texas Department of State Health Services by faculty certified screeners. This event was developed and planned to meet the academic course objectives of undergraduate and graduate nursing pediatric practicum courses. Phase II – BSN and MSN nursing students participated in on-site screening. Nursing school faculty worked closely with school district to logistically place 54 students in 27 elementary and middle schools in a span of 4 days. Certified student nurse screeners were grouped in 3 or 4 depending on number of school aged children needing to be screened. Phase III – MSN nursing students developed and piloted a telehealth school screening protocol so that future screenings may also be conducted remotely.
Results:
Phase I and II – Surveys were sent electronically to school nurses, clinical faculty and nursing students who described the learning experience as excellent. A frequent BSN response was that “[they] would consider school nursing as a potential chosen profession”. MSN students expressed their desire to “incorporate telehealth into their primary care practice”. Faculty observed that students benefited from this unique pediatric/adolescent clinical experience. Additionally, school health settings were ideal in meeting the often shortage in pediatric/adolescent clinical rotations in both BSN and MSN programs. Phase III – With the use of an on-site telehealth facilitator, the telehealth screening protocol had 100% concordance for vision, hearing, AN, and scoliosis using a smartphone application by screening methods (face-to-face vs video conferencing). Nursing student confidence in assessment and confidence in their ability to communicate via telepresence video was positive.
Conclusion:
The collaborative partnership between the school of nursing and the school district mutually benefited overarching goals of both agencies. The telehealth school screening protocol sets the stage for expansion of school-based screenings. Formative and summative evaluations of pediatric didactic and practicum courses found that school health learning objectives were met with high rankings. In addition, students were able to participate in service-learning activities that supported their professional role development. (895 words)