Insight Gained from School Nursing Record-Keeping

In recent years, the landscape of health issues involving school-aged children has become more intricate. Societal changes impact health care needs of children, and therefore, school nursing services. Current factors influencing health care needs include higher proportions of working parents, increased outpatient management of chronic illness, shorter hospital stays, higher rates of immigration, and larger numbers of children dependent on medical technology (Schainker, O'Brien, Fox, & Baucher, 2005). Record-keeping of student health data is one of the most challenging duties of school nurses (National Association of School Nurses, 2004). Presenting issues, including illness, injury, oral health problems, administration of medication, and hearing, vision, scoliosis, and body mass screenings, are documented in school nurse records. With only 45.1% of schools having the recommended nurse-to-student ratio of 1:750 (Brener, Wheeler, Wolfe, Vernon-Smiley, & Caldart, 2007), investigating why students visit a school nurse has the potential to showcase the need for compliance due to needs of students. The current study was designed to determine whether changes occurred in presenting issues when visiting the school nurse over a five-year period, and to identify factors that may have contributed to changes. A sequential, mixed method design (Creswell, 2003) was implemented. Presenting issues cited among students at a suburban high school upon visiting the school nurse were evaluated quantitatively using nurse records. Semi-structured interviews were utilized to explore perceptions of school nurses regarding why changes occurred in prevalence of presenting issues. Independent groups analyses of variance (ANOVA) were computed to determine whether differences in number of visits and occurrences of various presenting issues existed by academic year. Then, the transcriptions from the interviews were analyzed using a constant comparison method (Strauss, 1986). Though the total number of visits to the school nurse significantly decreased over the five-year period, several significant increases were found with specific presenting issues. More students visited the school nurse in the most recent year due to: mental/behavioral health support, administration of anticonvulsants and asthma and insulin medication, and blood glucose and blood pressure testing. Themes emerged from the qualitative data related to why changes may have occurred, including differences in school population and student needs. Awareness of trends related to health issues is paramount to success of school nurses. Increases in needs related to mental health and obesity indicate that beyond knowledge, enhanced training is desirable to support today's students (Nauta, Byrne, & Wesley, 2009).