NASN School Nurse

Since asthma is the most common noncommunicable chronic childhood disease in the United States, school nurses will encounter students with this health condition. The purpose of this article is to present the school nurse as the leader in directing the management of a student’s chronic health condition at school. This article provides a table of resources and discusses many aspects of asthma management, including utilization of the student’s asthma action plan, student-specific school accommodation needs, the importance of developing individualized healthcare plans, providing education to school staff related to asthma management and determining of the family and student knowledge level, as well as strategies to minimize exacerbations. The article also explores school nurse opportunity to advocate for emergency asthma medication access as a part of emergency preparedness. School-based asthma management can be complex and school nurses have a pivotal role in asthma management in a school.

The National Association of School Nurses supports pandemic control efforts. School nurses are advocates for their students, caregivers, school staff, teachers, and school administrators. With a clear understanding of how the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus evolves over time and changes transmissibility through mutations, school nurses gain understanding in epidemiologic calculation of herd immunity. To understand why the estimates of herd immunity fluctuate, as often reported in the news, school nurses need to understand how epidemiologist calculate this number. Obtaining herd immunity will protect the most vulnerable in the population. If all countries have access to vaccines and populations choose to receive vaccinations, herd immunity is more likely to be obtained. Equipped with knowledge of how herd immunity is calculated, school nurses are in a position to educate and advocate for the use of vaccines.

Local school wellness policies (LWP) guide school districts’ efforts to establish school environments that promote students’ health, well-being, and ability to learn that include school U.S. Department of Agriculture nutrition and physical activity requirements. Looking through the lens of the Whole School, Whole Community, Whole Child model and NASN’s Framework for 21st Century School Nursing Practice™, LWP can be expanded beyond the tradition focus of nutrition and physical activity to address the health and academic needs of students with chronic health conditions. School nurses need to be actively involved on district wellness councils as schools prepare to conduct their required triennial assessment of current LWP equipped with an understanding of the Alliance for a Healthier Generations’ updated model wellness policy and NASN’s supplemental wellness policy language to address management of students with chronic health conditions.

School nurses may deal with various common infectious eye, ear, nose, and throat–related chief complaints in regular practice. Recognizing the signs and symptoms of severe infection is paramount to preventing life-threatening complications that can have both acute and long-term implications. Distinguishing urgent and emergent eye, ear, nose, and throat conditions to send to the emergency department is integral to reducing the morbidity associated with these conditions. This article discusses three different students presenting with various chief complaints, from the initial assessment by the school nurse to the appropriate disposition and follow-up.

Asthma is the most common noncommunicable chronic childhood disease, affecting more than 5 million children in the United States. Asthma is the leading cause of school absenteeism. Treatments for asthma are divided into fast-acting medications that are used to relieve symptoms and slower acting (controller) medications that prevent symptoms. Albuterol is the most common fast acting medication for asthma, and it exists in multiple forms, including metered-dose inhaler and nebulized therapy. The use of spacers and holding chambers can further improve medication deposition in the airway. The cornerstone controller therapy for asthma is inhaled corticosteroid. Other medications for asthma include long-acting beta agonists, long-acting antimuscarinics, and antileukotrienes. The newest agents for controller asthma therapies are biologics.

Multidisciplinary collaboration for healthy student outcomes is not a new concept for school nurses nor is working with public health officials in promoting school–community initiatives. The SARS-CoV-2 (COVID-19; severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019) virus further highlighted the need to work together to promote best practice strategies to arm the community with information and guidance to prevent illness. The McHenry County Health Department recognized the expertise school nurses have in school health and formed a voluntary School Nurse Task Force. This collaboration worked to implement requirements for operating a school during a pandemic. The task force adapted those concepts into a toolkit to assist schools to meet health requirements throughout the most significant pandemic in over 100 years.

The importance of students feeling connected in school cannot be overstated, as this perception is crucial to support their health and well-being. A lack of school connectedness can lead to adverse physical and mental health outcomes, including bully victimization. Numerous factors, including individual, social, and environmental, influence students’ perceived sense of school connectedness. School nurses are well positioned to establish and maintain school connectedness due to their knowledge, accessibility to students, and familiarity with the school environment. This article details the importance of school connectedness and describes the associations between school connectedness, bullying, and mental health. In addition, we offer recommendations geared toward school nurses regarding strengthening school connectedness and promoting a culture of care and inclusivity within school environments, especially salient in the context of the COVID-19 pandemic.

Schoolchildren with sickle cell disease (SCD) experience physiologic and psychologic stress that can affect school functioning, mental well-being, and physical health. Student needs are unique and individualized; however, school nurses can support students and families with SCD through comprehensive and thorough care planning efforts. In addition to components specific to individual prescriptions and other nonpharmacological therapies, school nurses should consider school access and inclusion, pain management, racism, and disease self-management when care planning. As a healthcare provider who may have several continuous years of near-daily contact with students, the school nurse is an imperative provider, educator, and advocate for students learning to manage their SCD and avoid the related complications and challenges.