Integration of the Family Nurse Practitioner in a School Based Setting

1. Integration of the Family Nurse Practitioner in a School Based Setting Michelle Heusi Krystal Morris Spring and Summer 2012

2. Purpose Statement To determine the need and potential usage of Nurse Practitioners in Kansas public schools To perform a needs assessment by gathering aggregate data through a parent/guardian survey and by an open ended script to be completed by the school nurse

3. School Based Health Care First School Based Nurse Practitioners in the early 1970s Initial focus targeted teen pregnancy in inner city high schools Common goal of “decreasing school absenteeism and missed work days by providing convenient primary and acute care while children are in school”

4. Review of Literature • Databases • CINAHL, SAGE, Cochrane Keywords • Nurse Practitioners and Schools • School Based Clinics Key Points • Nurse Practitioners expand the care given in public schools • School Based Clinics with Nurse Practitioners are financially sustainable • Legal Issues and Scrutiny surround Nurse Practitioners in School Based Clinics

5. Martha Rogers The Science of Unitary Human Beings

6. Project Objectives Survey parents/guardians of Tecumseh South and Jennie Wilson Elementary students Perform written interviews of the nurses at both schools regarding their role and expectations of their job Analyze data results from the surveys to determine the needs for a Nurse Practitioner in the school based setting

7. Tecumseh South Elementary USD 450: Shawnee Heights School District in Topeka, KS 2011-2012 enrollment 468 students Kindergarten – 6th Grade Principal: Mr. Scott Dial

8. Tecumseh South Demographics Ksde.org

9. Jennie Wilson Elementary USD 457: Garden City, KS 2011-2012 enrollment 215 students Kindergarten- 4th grade Principal: Ms. Melinda Stewart

10. Jennie Wilson Demographics Kdse.org

11. Tecumseh South Implementation Online Survey sent to parents through email Email sent to 480 parents/guardians Survey emailed on April 16, 2012 and closed on April 30, 2012

12. Jennie Wilson Implementation Paper surveys sent home with students with consent form and envelope to use to return the survey to school 220 Parents Surveyed, 1/3 of surveys printed in Spanish Survey distributed on April 26, 2012, picked up from school on May 10, 2012

13. Data Analysis Tecumseh South Jennie Wilson 72 English surveys returned 15 Spanish surveys returned

22. Comments from Tecumseh South Parents • “What an asset nurse practitioner could be inside the school system. So often it is such a natural environment to identify needs, academic-social emotional-socioeconomic-personal-peer...not all families have access to the services they need but all children have access to a public education. Collaboration between school counselors/social workers, educators, and trained and qualified medical providers comprehensively assesses the whole person.” • “I would feel comfortable with having a NP at the school if the fees are included with the enrollment or at no cost to the parents. Also, the NP at the school would be in addition to and not replacing the family Doctor.” • “This survey does not really pertain to my child in that she has health insurance readily available to her. If she did not, then I believe a school-based health service would be great.”

23. Comments from Jennie Wilson Parents • “Nurse practitioners in schools are a great assist, especially for families that aren’t able to afford to take their kids to the doctor. • “It is nice to have medical services offered in a convenient fashion, however a parent should never be told which medical services are required for their child.” • “I think it would be of great assistance for those children without access to health care.” • “If the ARNP could see my child year around and work with the pediatrician, I might let them treat my child’s asthma and other chronic issues.”

24. School Nurse Script • How many hours are you present in the school weekly? • When you aren’t present in the school, who is responsible for the healthcare of the students? • In your own words, what do you consider your job description? • As a school nurse, what types of chronic conditions do you see among your student population? • Do you know specific numbers of students with each condition? • What are the most common reasons that students at your school come see you? • On an average week, approximately how many students do not come to school because of illness? • On an average week, approximately how many students leave school early due to illness? • Do you have specific criteria for sending students home early from school? • Do you feel that your students have primary care providers outside of school? Where do you think they get their primary care at?

25. Dissemination of Plan • Project objectives were met: • Aggregate data was gathered regarding current health care, potential usage, and concerns about Nurse Practitioners in the school setting • Description of roles and expectations of the Nurse at both schools was explored • Data synthesis and comparison was made with data from each school