The medical care that children receive at school never is included in the public health descriptions of child health care utilization patterns. Researchers in this study note that there are many reasons for school-based health services: higher portions of working parents, increased out-patient management of chronic illness, shorter hospital stays, higher rates of immigration, and larger numbers of children dependent on medical technology who are mainstreamed into regular classrooms. Three years ago, a literature review cited 15 articles that described school nurse-led interventions. These interventions led to positive health outcomes such as: higher rates of immunizations, lower rates of injuries at school, and lower asthma severity. School-based health centers have also been associated with better health outcomes and reduced school absences.
In this study (performed in 2001/2002), individual student encounters with schools nurses at Boston Public Schools were studied. This school district had over 63 thousand children of whom 71% were eligible for free or reduced-price lunch. The district’s student population was comprised predominantly of minorities (48% black, 28% Hispanic, and 9% Asian).
Results demonstrated the following: Most encounters were episodic care (58%) and of these, most were illness assessments (34%), first aid (20%), and health education (18%). Other encounters were medication administration (32%). Of these, most were psychotropic agents (71%) and asthma medications (16%). Blood glucose assessments (25%), blood pressure measurement (22%) and peak flow assessment (17%) were the most frequent evaluations. The average student without an individualized health care plan (IHCP) had 7 episodic and screening encounters with a school nurse per year. Almost 4% of the student population had an IHCP and these students averaged 118 encounters per year. On an average month, school nurses provided 12 classroom presentations and 4 support groups. After an encounter, 11% were followed by verbal communication with a parent, 4% with a school staff, and 1% with a physician.
(Schainker E, et al, Arch Pediatr Adolesc Med 2005; 159:83-87.)
Comment: How comparable is this with your school district? In Boston, 63 thousand students attend 131 schools. There are 93.5 (full-time equivalent) school nurse and an additional 10 of what the district calls ”paraprofessional” nurses. I am sure school nurses perform a different range of activities when they work for districts with less desirable nurse-tostudent ratios. Nevertheless, this is a great first step to documenting how nurse-student ratios affect the level of care that can be provided. —H.T.
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