Remote diabetes monitoring has transformed Type 1 Diabetes (T1D) management in schools, yet its impact on school nursing practice remains poorly understood. This study explored how remote diabetes monitoring is reshaping the role of school nurses caring for students with T1D in Indonesia. Using an Interpretive Description approach, semistructured interviews were conducted with 20 school nurses from 15 schools between November 2025 and February 2026. Data were analyzed inductively. Five themes emerged: living in a state of constant digital vigilance, negotiating responsibility in real-time care, managing parental expectations in an era of shared data, redefining professional boundaries and clinical decision-making, and transforming the school nurse role in the digital era. Findings indicate that remote diabetes monitoring extends school nursing beyond episodic care, fostering more proactive, data-driven, and continuously connected roles. Training, policy development, and clearer role expectations are needed as digital health technologies become increasingly integrated into school-based diabetes care.
Screening for autism spectrum disorder (ASD) relies on caregiver reports during primary care visits, yet teachers offer an underutilized perspective for school nurses conducting community-based assessments. This study describes caregiver-teacher concordance on ASD-related behaviors in preschool children and identifies predictors of differences in ASD-related behavior ratings in the Jintan China Child Cohort (N = 1,209) using the Child Behavior Checklist and Teacher Report Form.Only 4.1% of children were identified with concernts by both informants and 24.7% showed disagreement; mothers reported concerns more often than teachers. Threshold-based concern ratings were positively associated (OR = 2.07, p < .001) and concordance was small (κ = 0.11, p < .001). Prenatal secondhand smoke exposure was associated with greater teacher concern (β = -0.48, p = .019); co-sleeping arrangements (β = 0.66, p = .020) and birth complications (β = 0.43, p = .036) were associated with greater maternal concern. We provide three fictional vignettes for school nursing practice.
The number of children with medical complexity has been increasing annually, resulting in a growing demand for appropriate support from nurses in school settings. However, the lack of standardized criteria and clearly defined job descriptions presents a significant challenge in securing and retaining personnel. This study aimed to clarify the current status of school nurses, their perceptions of professional roles, and barriers to effective care. A paper-based questionnaire survey was conducted, followed by semistructured interviews with school nurses in City A, Japan. Responses were obtained from 34 participants (response rate: 71%). Witnessing students' growth and ensuring their safety were identified as key sources of professional fulfillment and motivation. In contrast, many participants described themselves as "extra workers," reflecting low self-esteem and role ambiguity. These findings indicate that school nurses experience considerable anxiety and role-related challenges, highlighting the need for guideline development, systematic support, and structured training programs.
Although nurses have been working in Australian schools for many decades, research has focused primarily on narrow aspects of clinical practice or service delivery in specific regions. The aim of this study was to identify the domains of practice registered nurses report in a typical working day in Australian schools, using interview data from a national sample. Forty-five nurses working in government and nongovernment schools in every state and territory of Australia participated. Interviews were analyzed using inductive content analysis ( Elo & Kyngas, 2008). Six distinct domains of practice characterized nursing work in Australian schools: (i) responding to diverse individual health needs, (ii) promoting health to groups, (iii) working with families, (iv) planning for health needs at school, (v) collaborating for positive student outcomes, and (vi) facilitating service delivery. Collectively, Australian registered nurses deliver a comprehensive range of services at the individual, group, family, and school level.
Work-related stress has been examined in traditional healthcare settings, yet the well-being of school nurses remains underexplored. This collective qualitative case study examined workplace factors and school nurses' psychological well-being. Data collection was guided by the Neuman Systems Model using sociodemographic questionnaires, semi-structured interviews, and journaling to explore intra-, inter-, and extra-personal workplace factors. This manuscript reports findings from questionnaire, interview, and journal data. Results showed that well-being was achieved through organizational and relational conditions rather than individual coping alone. Team membership, professional recognition, role clarity, and schedule flexibility promoted psychological security through inclusion in decision-making, respect for clinical expertise, and clear reporting structures. Exclusion, role ambiguity, and limited authority undermined well-being. Relationships with students provided meaning that sustained school nurses' commitment to the profession despite rising medical acuity and workload. These findings highlight the need for structural workplace interventions to support school nurse well-being and ensure safe student care.
Anxiety disorders are among the most common pediatric mental health concerns, affecting nearly one in ten U.S. children, and often present as unexplained somatic complaints in school health offices. In rural Montana, limited access to behavioral health care compounds these challenges. This quality improvement project tested a nurse-led case-finding protocol (≥3 unexplained somatic visits in 6 weeks) followed by targeted anxiety screening using the Screen for Child Anxiety Related Emotional Disorders (SCARED) administered in both child self-report (SCARED-c) and parent-report (SCARED-p) versions, within a Screening, Brief Intervention, and Referral to Treatment (SBIRT) framework. Of 430 students, eight met case-finding criteria, six completed screening, and five screened positive. All received a nurse-delivered brief intervention and counseling referral. Guided by Plan-Do-Study-Act cycles, the project demonstrated feasibility, sustainability, and the critical role of school nurses in early anxiety recognition within resource-limited settings.
Bullying is a prevalent form of interpersonal violence in childhood. Sleep disruption may represent a modifiable factor linking bullying exposure to school outcomes, yet population-level evidence remains limited. Using pooled 2022-2024 National Survey of Children's Health data, we examined associations between bullying exposure, sleep health (short sleep, <9 h; bedtime consistency), and chronic absenteeism due to illness or injury (≥11 missed school days) among U.S. children aged 6-11 years (up to n = 45,118). Approximately 45% of children experienced bullying in the past year. Bullying exposure was associated with higher odds of short sleep, with graded increases for occasional and frequent bullying. Bullying was also strongly associated with chronic absenteeism. In sequential models, bedtime consistency remained independently associated with chronic absenteeism, whereas short sleep was not significant after accounting for bedtime consistency. Findings identify bedtime consistency as the sleep indicator most consistently associated with absenteeism risk in middle childhood.
This study explored concussion knowledge, education, and organizational policies among school nurses (n = 12) and youth athletic program leaders (n = 14) in the Philadelphia area from June-September 2023. Using semi structured interviews, questionnaires, and thematic analysis, three themes emerged: (1) School nurses and youth athletic program leaders know their roles in concussion management but welcomed more education. (2) System-level gaps in concussion oversight beyond organized sports exist for younger children, those injured via non-sport related mechanisms, in recreational settings, or during free play. (3) Challenges in concussion care exist including lack of concussion awareness, parental engagement, language barriers, and access to health care. Although both school nurses and athletic leaders generally possess baseline concussion knowledge, they identified missed cases, particularly non sport related injuries, and insufficient return to play or return to learn procedures in recreational environments. Findings highlight the need for targeted, community specific concussion education to address disparities in youth concussion management.
Contemporary school nursing practice increasingly emphasizes the role of school nurses in supporting student mental health through interdisciplinary collaboration. Using data from a national online survey of school nurses (n = 1,283), this study examined associations among caseload, collaborative practice, and moral distress related to school-based suicide prevention. Serving a greater number of schools was associated with lower levels of collaboration with school-based mental health professionals. Lower levels of collaboration were associated with a higher likelihood of experiencing moral distress, suggesting that collaborative challenges may reflect broader workload constraints. Although caseload size was not directly associated with severity of moral distress, findings suggest that workload demands may contribute indirectly to moral distress through collaborative engagement. Attention to workforce structures alongside strengthening opportunities for collaborative practice may be important for addressing moral distress and supporting school nurses’ participation in student mental healthcare.
Vaping is a concern in schools. School vape detectors could discourage vaping inside the school; however, there is no evidence of their effectiveness. This study investigated high school student and staff perceptions of vape detectors in a public school district in northwestern Ontario, Canada. Two school principals conducted interviews and students ( n = 58) and staff ( n = 73) in all area high schools ( n = 5) completed online surveys. Open-ended questions assessed perceived challenges and benefits of vape detectors. Responses were coded and a thematic analysis identified major themes. Perceived benefits of vape detectors included helping identify students who vape at school, discouraging vaping at school, and improving restroom access. Perceived challenges included students evading detection and vaping moving to other locations at school. School staff and students within these schools identified various perceived benefits and challenges with vape detectors. Additional evidence is needed for the impacts of vape detectors on student vaping.
Asthma exacerbations are preventable, costly, and a common cause of school absenteeism. Using Group Concept Mapping, we interviewed school nurses, staff, school-based providers, and families/caregivers (N = 31). We elicited feedback regarding social circumstances relevant to asthma exacerbations in schools and then participants prioritized those circumstances. Perspectives of our 31 participants produced 84 statements, grouped into 10 clusters and rated separately on the impact and feasibility of preventing asthma exacerbations in schools. The highest rated clusters were Exposure to smoking / vaping and Caregiver / Child lack of asthma education. Stakeholders identified a variety of factors, with some rated as highly impactful yet less feasible to address. Important circumstances are recognized by multiple stakeholders, yet are underresearched, especially to guide collaborative school-based interventions. Our findings can be used to prioritize feasible and impactful interventions in collaboration between school nurses, staff, school-based providers, and families, ultimately decreasing the suffering of children with asthma.
Anxiety and depression are major challenges among school-aged children. This study investigated whether the association between asthma and anxiety and/or depression was significantly greater among children who experienced caregiver incarceration (CGI) compared to those without CGI. Using the National Survey of Children's Health (2016-2020) data, we estimated the effects of asthma and CGI on anxiety and/or depression among school-aged children (age 6-17) (N = 125,005). Data were analyzed using multivariate techniques in R Software. Asthma and CGI were positively associated with anxiety and depression. Notably, increased anxiety and depression associated with asthma were significantly greater among children who experienced CGI versus those who did not. The joint effects of asthma and CGI on mental health are significantly greater than their individual effects. School-based interventions are needed to address the mental health challenges of children affected by asthma and CGI. Improving asthma management and supporting children with CGI may mitigate the mental health burden.
Nurses play a crucial role in promoting school health by supporting students' resilience in the context of bullying. This cross-sectional study examined the influence of school climate and moral disengagement on resilience among 167 Thai secondary students using Partial Least Squares Structural Equation Modeling. Participants included 38.3% victims, 28.7% perpetrators, and 32.9% bully-victims. Most students reported medium to high levels of resilience and positive perceptions of school climate. Boys were more likely to report moral disengagement (p < .001). Structural modeling indicated that school climate was positively associated with resilience (β = 0.471, p < .001). Moral disengagement was not significantly associated with resilience, and mediation through moral disengagement was not supported. The model accounted for 27% of the variance in resilience. These findings suggest that positive school climate is closely linked to students' resilience and underscore the relevance of school-based nursing practices that emphasize inclusive, relational, and system-level approaches.
School nurses are often looked to coordinate care for students with a concussions. School-based concussion return-to-school policies may help provide guidance to help school nurses navigate this process. Using data from the 2024 School Pulse Panel (a nationally representative sample of U.S. public school principals), the purpose of this study was to assess the prevalence of school-based concussion policies and their components (e.g., staff training, accommodations for students). Results from 1,683 respondents showed that most principals (75%) reported that their school had a concussion policy during the 2023-2024 school year. Of those with a concussion policy, 58% reported that their concussion policy included information on how to support students in the classroom and 29% responded that their concussion policy required training for staff on concussion. Dedicated efforts to promote comprehensive policies and standardization of best practices may be beneficial to promote uptake and limit inconsistencies in concussion management plans and practices.
This study examined the association between adverse childhood experiences (ACEs) and digital media overuse among Korean adolescents using Bronfenbrenner's ecological systems theory. A secondary analysis of the Panel Study on Korean Children (n = 1,316) was conducted. Overall, 63.1% reported at least one ACE, and 56.6% met criteria for digital media overuse. In adjusted logistic regression models, having three or more ACEs was significantly associated with higher odds of digital media overuse (3 ACEs: adjusted odds ratio [aOR] = 1.97, 95% confidence interval [CI] = 1.14-3.41, p = .015; 4 ACEs: aOR = 3.81, 95% CI = 1.69-8.58, p < .001). Older age, female sex, and better school adjustment were associated with lower odds, whereas higher maternal parenting stress and academic stress were associated with greater odds. These findings support ACE-informed, family-centered prevention strategies within school health systems.
