The Journal of School Nursing

An integrative review of literature was undertaken to examine the impact of children’s mental health on their school success. The literature confirmed a confluence of problems associated with school performance and child and adolescent mental health. Poor academic functioning and inconsistent school attendance were identified as early signs of emerging or existing mental health problems during childhood and adolescence. Among the goals of school nursing is to provide a process for identification and resolution of students’ health needs as they affect educational achievement. Thus, it is within the scope of practice and goals of school nursing to also address children’s mental health needs, as they affect school performance. This review of literature supports the conclusion that school nursing is well positioned to respond to the need for mental health promotion, illness prevention, and early intervention related to children’s mental health.

The Female Athlete Triad is a syndrome of the interrelated components of disordered eating, amenorrhea, and osteoporosis. Sometimes inadvertently, but more often by willful dietary restriction, many female athletes do not ingest sufficient calories to adequately fuel their physical or sport activities, which can disrupt menstrual functioning, thereby increasing their risk of bone loss. Although its prevalence is unknown, the Female Athlete Triad is believed to affect many athletes at all ages and all sport competition levels. Even though the Triad affects athletes in all sports, girls and women in sports that emphasize a thin or small body size or shape appear to be most at risk. This article focuses on the risks of the Female Athlete Triad for middle-and high-school-age female athletes as well as the unique issues related to the identification, management, and treatment of the various components of the Triad in this special adolescent subpopulation.

School nurses often have the responsibility to ensure that students meet all immunization requirements for school entry and school attendance. In large inner-city school districts, many obstacles exist which make this task daunting and often result in lengthy absences and exclusions for students. It is critical that school nurses find creative and systematic ways to meet these challenges, which include working parents, lack of access to primary care, lack of transportation, cost of immunizations, poor compliance and follow-up, myths regarding immunizations, and the impact of the Health Insurance Portability and Accountability Act (HIPAA) legislation. This article describes an immunization project that removed most of those barriers for high-risk students and gave the school nurses tools to succeed in achieving higher levels of immunization compliance in inner-city schools. Since the immunization project’s conception, compliance in the district has risen from an overall level of 50–60% to 90–100%, along with better record-keeping and the prevention of exclusions.

Chronic victimization by bullies has been associated with academic failure in adolescence, as well as adjustment difficulties, depression, and suicidal ideation. Relational aggression is a form of bullying that is a problem for adolescent girls. It often takes the form of damaging peer relationships and includes verbal assaults such as teasing or name calling, as well as psychological attacks such as gossip, social exclusion, and strategic friendship manipulations. A girl’s ability to identify these indirect attacks may be imperative for her to enact an effective defense. Because many students do not recognize relational aggression as a form of bullying, their experiences often go unreported to parents or teachers. School nurses may be the front line of defense. With this in mind, school nurses must be informed about bullying behaviors, equipped to identify these behaviors, and prepared to intervene with victims as well as perpetrators of bullying.

Youth participation in sports has increased greatly over the past 20 years. Consequently, there has been a rise in the number of sports injuries. A study was conducted to determine teen’s level of physical activity, knowledge about risk factors for sports injuries, use of protective equipment, and parental involvement. Two groups of teens, one of which was required to take a physical education class, were given a self-administered, written survey. The study found that the teens in this small Virginia town have a high level of involvement in sports and other physical activity and good general knowledge of sports injury prevention. Improvement is needed in the use of protective equipment when participating in informal sports activities and in the provision of sports injury prevention education to parents. As advocates for student health, school nurses are in a unique position to educate students, parents, staff, and the community about prevention of sports-related injuries.

Qualitative research using the symbolic interactionism framework and grounded theory methodology was employed to discover the perceived health problems and dangers that homeless families with children endure. Data were collected using semistructured interviews from 34 homeless volunteer participants with 87 children. An in-depth analysis of the data using the constant comparative method led to recurrent descriptors and patterns, which were synthesized under four themes: external locus of control, deterrents to health, economic barriers, and lack of support. The findings indicate that there is an urgent need for preventive approaches to alleviate homelessness and its attendant health problems. Recommendations consistent with current federal, state, and local strategies and plans for the early identification and prevention of homelessness are presented. School nurses have an important role as advocates, health educators, and coordinators to promote realistic strategies, programs, and policies in the delivery of services to homeless families.

The purpose of this study was to explore Kanter’s Theory of Structural Power in Organizations, using school nurses and to answer the research question of whether there is a relationship between empowerment and autonomy in school nurses. This study found a positive relationship between the nurses’ perceptions of empowerment and autonomy. The school nurses surveyed perceived themselves to have a high degree of autonomy and a moderate degree of empowerment, and they reported that their access to informal power structures was higher than their access to formal power structures in their school systems. School nurses can benefit by understanding factors that can increase their empowerment in the workplace. They need to understand the organizational structure of their workplace to increase their effectiveness and job satisfaction.

School nurses and health office employees are the creators and caretakers of legal documentation. School nurses have an ethical and legal obligation to protect the integrity of electronic student health records. Although there are many threats to data integrity, from inadequate hardware to electrical surges, one of the most pervasive threats to data is computer viruses. There are many precautions that can be taken to protect electronic student health data from viruses in the school health office.

This article addresses practice issues related to school health records and school nursing documentation. Because the issues have been posed by practicing school nurses, the article is in Question and Answer (Q&A) format. Specifically, the questions addressed concern the following: ownership and storage location of student health records when the school nurse is contracted from a community health agency rather than employed by the school district; documentation of sensitive health information on students’ health records including pregnancy, drug and alcohol abuse, mental illness, history of suicide attempt, and HIV status; inclusion of medical diagnoses and current medications on a student’s Individual Educational Program (IEP); and Health Insurance Portability and Accountability Act (HIPAA)-permitted communications between school nurses and health care providers related to students’ immunization status, regarding a student’s treatment needs in school, and via facsimile (e.g., records of immunizations, completed physical examination forms, and medical orders). HIPAA, the Family Educational Records and Privacy Act (FERPA), and other laws are addressed as appropriate, and resources for obtaining further information are included.