Running Head: CULTURE PERSPECTIVE SCHOOL NURSING

Public Health Nursing in School Setting Culture Perspective Paper MSU Team 1- Holly Atterberry, Karen Gaddy, Angie Shaw, & Loridan Moore

CULTURE PRESPECTIVE SCHOOL NURSING School Nursing in Missouri and Arkansas Working in the school setting as a public health professional, there are concerns for health promotion, prevention of disease, and rehabilitation for students if needed. According to the National Association of School Nurses, the definition of school nursing is, a specialized practice of professional nursing that advances the wellbeing, academic success, and life-long achievement of students. (National Association of School Nurses, 2012). Working in the school setting, the focus of public health nursing is prevention and implementation of the referral process for families to receive appropriate resources to help maintain health in the children. Being in an educational setting, initiative needs to be taken by school

nurses to begin the process of educating students on good health. To maintain good health, one must understand what health is. The World Health Organization defined health as, a state of complete physical, mental, and social well-being, and not merely the absence of disease. (World Health Organization, 2012). A school nurse must understand the different age groups and developmental stages that are in the school setting, as well as the external factors that affect the health of students. Once these factors have been determined, it is necessary to assess the communitys needs and implement resources that are available to help students reach their maximum potential in health and education. To better understand the needs of the children in the schools, community assessments were completed of three schools in Missouri, Houston, Lebanon, and West Plains, and one school located in Berryville, Arkansas to determine resources available. A review of these areas and resources

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available will bring insight to the culture and issues school nurses overcome to help their students have a state of complete physical, mental, and social wellbeing. To play a critical role as a school nurse, one must understand the age groups and developmental stages of children from the preschool ages, four to five year olds, school ages, six to twelve year olds, and up to the young adult ages, thirteen to eighteen years old, which presents a wide range of developmental stages. It is important to understand the challenges that children have to overcome in order to develop adequately, and better understand how to care for them. For children to do their best throughout school, it is important they understand what health is and learn how to maintain it. In the school setting, different aspects of health need to be addressed throughout the years of development. According to Eriksons Developmental Stages, in the elementary years, children are faced with gaining a sense of purpose and developing a sense of industry (Harder, 2011). At this young age, teaching health promotion and prevention begins with simple ideas, such as hand washing, healthy foods, dental hygiene, and germ prevention. Once children reach the adolescence stage, ages twelve to eighteen, these young adults have to develop self-identity (Harder, 2011). Health promotion, prevention of disease, and rehabilitation is concerning related to the different influences students face by peers, parents, media, and other role models. While the physical health is still important, there is large concern of mental and social health in this age group. Education regarding outside influences that affect health need to be addressed, such as body image, sex education, alcohol and drug abuse, drop-out rates, sleep habits, and many other issues, to maintain good health. Once these factors are determined

CULTURE PRESPECTIVE SCHOOL NURSING related to the age groups, it is significant to understand the community resources around the school district. Upon assessment of communities surrounding the school districts, there

were multiple programs, government funded and non-government funded, available that school nurses could take advantage of to help students. The issues that were noted were mostly related to a poor socioeconomic status, such as nutrition, medication availability, education, clothing and school supply availability. To combat these issues, the school nurses uses the available resources to help students maintain a stress free, healthy environment related to physical, mental, and social wellbeing. For example, to maintain physical health a school nurse can help students and their families to obtain prescription medications through government entities or ensure that children are eating adequate meals for supper. A school nurse may act as a counselor or refer a student to appropriate mental health services if needed to maintain appropriate mental health. By encouraging healthy relationships, the nurse will ensure her students have social wellbeing. Assessment of the Lebanon School District revealed several agencies and programs that were available to assist in food, clothing, shelter, and health promotion to ensure adequate health. The Lebanon School District includes 8 schools that serve 4,643 students preschool through twelfth grade. The dropout rate in 2008 was recorded at 4% compared to the national rate of 4.4%. The district spends $7,067 per pupil in current expenditures (Lebanon R-III School District, 2012). It was astonishing to see the roles the Lebanon School District nurse played, even though there were so many resources were available, such as nurse, doctor,

CULTURE PRESPECTIVE SCHOOL NURSING counselor, mother, clothes closet, food pantry, and friend. When the nurse see the

need of students outreach her abilities within the school, the referral process begins. One of the resources available in Lebanon, Missouri is Missouri Ozarks Community Action, which is a non-profit community action agency. Through this service, lowincome families are able to find head start for children ages three to five years old, apply for a housing choice voucher program to acquire safe and sanitary housing, or take life skill classes (Missouri Ozarks Community Action, 2012). The Laclede County Health Department is also available for multiple services to ensure health of the students. As a government funded entity, applications for government programs such as Women, Infants, & Children program are available to ensure there is money available to buy groceries (Laclede County Health Department, 2012). The health department can even act as a physicians clinic for families without health insurance twice a week. Statistics show that there are currently 7,353 food stamp recipients monthly, 255 families receiving temporary assistance, and 98 children receiving subsidized child care in Laclede County (Missouri Department of Social Services, 2012). These statistics show that these referral services are being used in families in this school district, but in some cases the assistance is not enough causing the multiple roles of the school nurse. The next school district assessed was in West Plains, Missouri home to elementary, middle, and high school campuses, as well as a community college, a distance campus for Missouri State University. There are three full-time nurses and one part-time nurse to provided care to almost 1,900 students and staff. In this school district, it was evident that the school nurses are not only serving their

CULTURE PRESPECTIVE SCHOOL NURSING students, but the families involved with the students care. The school nurses in this district are active in finding programs they feel will benefit their students and families to encourage the best health possible. The multitude of resources available in this area are listed on the school districts website. There is everything from transportation services to recreational activities to healthcare clinics to domestic violence resources (Community Resource and Services, 2011). Due to the open communication between needs of the students and nurses, the appropriate

resources are found and utilized. The county health department is also available as a referral service, but the West Plains school district has numerous direct programs and contacts to refer families and students too. The one school district that was assessed in a different state was the Berryville, Arkansas School District. This school district has approximately 1,795 students currently enrolled with four different campuses, elementary, intermediate, middle, and high school. This school district is located in a rural area, which lacks in general hygiene care and nutrition due to poor socioeconomic status. While the socioeconomic status may not be the greatest, there are multiple resources, government funded and non-government funded, available to assist students and families in needs. This community has several churches that provide items, such as hygiene products and food. Some of the government programs consist of a nutrition assessment programs and ARkids insurance for healthcare. The one drawback is that both charity and government funded programs have income guidelines that must be met to acquire benefits. For instance, the maximum gross income for a family of four can be on greater than $2,400 per month, which would allow up to a

CULTURE PRESPECTIVE SCHOOL NURSING maximum benefit of $668 per month from the nutrition assessment program (Berryville School District). In a different case, the school offers a program to any student who wants to participate to take home a backpack filled with food to take home on Friday to provide food over the weekend, or even every night to ensure they have a nutritious meal every night. This programs helps students and families have nutritious food and ensure appropriate diet at home. The community surrounding the school district offers parks and outdoor space for families and children to exercise. These services help students maintain adequate health throughout their time at school. The last school district to discuss is the Houston R-1 School District. This school is located in Texas County, which is the largest county in the state of Missouri. Houston has three different schools, elementary, middle, and high school, and has approximately 1,000 students. There are two full-time nurses, one for the elementary building and one that covers both the middle school and high school. This school district is similar to others regarding the poverty that surrounds the community. It was found that approximately 50% of students were eligible and enrolled for free or reduced lunches in 2009, unemployment rate was 9.3% for adults, and over 30% was receiving food stamp benefits (Kids Count, 2009). To ensure families are receiving adequate food at home for their children, programs such as Women, Infant, and Children can be referred or assistance from the local

food pantry can be used. The county health department is located in Houston, which allows children to receive their immunization or vaccinations for free (Texas County Health Department, 2011). Referral services in Texas County are mostly

CULTURE PRESPECTIVE SCHOOL NURSING government-funded programs. There are a limited number of private resources the nurse can utilize in this area. At times, local churches or organizations may have

programs, which improve the health of the students, otherwise places like the Texas County Health Department, Texas County Food Pantry, Division of Family Services, and others can be utilized. Through assessment of these communities that surround the school districts that are used for clinical sites bring insight to different resources related to nutrition, health care, and other aspects of health for students. It is important to understand the areas that were assessed consist of a majority of low-income families. This creates a challenge for school nurses because students and families expect her to play a multifaceted role in their lives. It is evident school nurses have a wide variety of roles to encourage appropriate health of the students so they can achieve their maximum potential. Due to the poor socioeconomic status of these areas, there are a limited number of private resources related to the government resources. It can be noted that the school district with a better socioeconomic status, West Plains R-7 School District, had a complete list of community resources on their own website that parents can access directly. Even though majority of families in these communities have a poor socioeconomic status, there are resources available to maintain good health of the students. As a school nurse, there is a responsibility that lies in picking up on the students who may need more attention to obtain the level of health they need. Being aware of the issues that are affecting the students within the school will help the school nurse assist children and their families in maintaining a state of complete physical, mental, and social wellbeing.

CULTURE PRESPECTIVE SCHOOL NURSING References Berryville School District (n.d.). Retrieved from http://www.trulia.com/schoolDistrict/AR-Carroll_County/Berryville_School_School_District_27/ Harder, A. (2011). Erik Eriksons stages psychosocial development. Enrich your life and your relationships. Retrieved from http://www.support4change.com /index.php?option=com_content&view=article&id=47&Itemid=108 Laclede County Health Department (2012). Listing of services. Retrieved from http://laclede.lphamo.org/ListingofServices/ListingofServices.html Missouri Department of Social Services (2012). Childrens division. Retrieved from http://dss.mo.gov/cd/office/laclede.htm Missouri Ozarks Community Action (2012). Head start. Retrieved from http://www.mocaonline.org/headstart.php National Association of School Nurses (2012). Planning a career in school nursing.

Retrieved from www.nasn.org/RoleCareer/PlanningaCareerinSchoolNursing Texas County Health Department (2011). Child health. Retrieved from http://www.texascountyhealth.org/Child%20Health.aspx Unknown (2011). Community resources and services. Retrieved from http://wpr7. schoolwires.net/cms/lib2/MO01001590/Centricity/Domain/52/ Community%20Resources%20and%20Services%20current%20as%20of%2 09%206%2011.pdf Unknown (n.d.) Berryville School District. Berryville School. Retrieved from http://bobcat.k12.ar.us/ Unknown (2010). Food for kids. Rice Depot. Retrieved from http://www.ricedepot.

CULTURE PRESPECTIVE SCHOOL NURSING org/ffk.asp?t=Food%20For%20Kids. Unknown (2012). Lebanon R-III School District. Retrieved from http://www .education.com/schoolfinder/us/missouri/district/lebanon-r-iii-school district/#learn-more
World Health Organization (2012). Frequently asked questions. Retrieved from

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http://www.who.int/suggestions/faq/en/index.html