Complete ONE reflective clinical journal entry for each clinical day and put in the designated drop box. Your journal article MUST be attached to your assignment. Not submitting your article results

Complete ONE reflective clinical journal entry for each clinical day and put in the designated drop box. Your journal article MUST be attached to your assignment. Not submitting your article results
Running head: CLINICAL JOURNAL Clinical Journal MY JOURNAL Remedial attendants are regularly the first human services proficient to see a prisoner about an ailment. An exhaustive appraisal enables the medical attendant to decide care prerequisites. This could mean conveying nursing care legitimately or masterminding the patient to see a doctor or propelled professional. Restorative attendants should regularly work intimately with prison guards in the circumstances, for example, crises in the lodging units or observing detainees for therapeutic consideration. These medical caretakers are tested to give the most extreme medicinal services in a setting with a mission and structure for different purposes – security and open wellbeing. In this way, assets can be constrained, and imagination is required. (walk, S.2012 ) Intake Screening: Remedial legal attendants screen prisoners entering the office for an assortment of immediate medicinal and emotional wellness needs, for example, liquor or medication withdrawal, suicide potential, injury, irresistible maladies, and ceaseless meds. This screening helps care with lodging arrangement, starts booking for progressing wellbeing visits, and decides whether the detainee should initially be found in an intense consideration setting for damage treatment. Chronic care clinic: Detainees are planned for customary arrangements in the therapeutic unit to oversee interminable conditions, for example, hypertension, asthma, and joint pain. Likewise, endless consideration facility visits may be planned to take care of irresistible procedures or pregnancy the executives. Even though a ceaseless consideration visit includes contact with a doctor or propelled specialist, remedial legal attendants give key components of unending consideration the executives including quiet instruction and drug consistence survey Medication administration: On the grounds that many prescriptions, even over-the-counter arrangements, can be abused in the restorative condition, these drugs must be regulated exclusively through a prescription pass or pill line process. A few times day by day, the prisoner populace requiring drug portions report to a medical attendant for the organization. This might be brought together in the therapeutic unit or decentralized with nursing staff managing drug in the lodging unit. Nursing sick Call: Medical attendants give verbose social insurance administrations to restorative patients through a solicitation framework called Wiped out Call. Prisoners demand treatment, for the most part, recorded as a hard copy, and are seen by a medical caretaker. Institutionalized conventions permit organization of over-the-counter meds for straightforward conditions like competitor’s foot, obstruction, or the typical virus. If the nursing evaluation shows a severe condition, a subsequent meeting with a doctor or propelled specialist is orchestrated. (Bodenheim, T. 2002). Nursing preparing is a blend of casual and down to earth learning encounters that empower nursing understudies to get the information, abilities, and frames of mind for giving nursing.Nursing instruction is made from two integral parts: hypothetical preparing and handy preparing A large piece of nursing training is completed in the clinical situation. In Iran and numerous different nations, clinical practice frames the more significant part of the formal instructive courses in nursing. Accordingly, clinical instruction is viewed as an essential and necessary piece of the nursing training program. Since nursing is an exhibition-based calling, clinical learning situations assume a significant job in the securing of export capacities and train the nursing understudies to enter the nursing calling and become an enrolled attendant. Besides, the clinical territory of nursing training is of extraordinary significance for nursing understudies in the determination or dismissal of nursing as a calling. In contrast, to study hall instruction, clinical preparing in nursing happens in a complex clinical learning condition which is impacted by numerous elements This condition gives a chance to nursing understudies to adapt tentatively and to change over hypothetical information to an assortment of mental, mental, and psychomotor aptitudes which are of essentialness for patient consideration. Understudies’ introduction and planning to enter the clinical setting are one of the significant components influencing the nature of clinical instruction. Since an ideal clinical learning condition positively affects the understudies’ proficient improvement, a poor learning condition can affect sly affect their expert advancement process. Based on the consequences of the investigation, numerous understudies do not have the relational abilities essential for viable correspondence in the clinical condition. It is proposed that the strong relational skills are educated to understudies before they enter the clinical requirement with the accentuation on the contrasts between the clinical situation and the study hall condition. In perspective on the aftereffects of the investigation, numerous understudies referenced the absence of hypothetical information and reasonable aptitudes as one of the issues associated with providing care. In this manner, before understudies enter the clinical condition, it ought to be discovered that they are hypothetically and for all intents and purposes arranged as they step through exams and give care in the ability lab. In light of the nearness of stress and feelings of inadequacy in understudies in going up against the clinical condition, it is recommended that while they get mental discussion on the nursing calling, providing care, and the medical clinic condition plans be made for them to visit the emergency clinic and to get to know the clinical learning condition before they start the real temporary job. Pediatricians ought to set up a working association with the school medical attendants who care for their patients with ceaseless conditions to guarantee that singular patients’ wellbeing plans are executed viably inside the school. Likewise, pediatricians’ correspondences with school medical caretakers concerning their patients ought to be adequately clear and point by point to control school nurture in directing the consideration of individual youngster. Pediatricians can offer direct help of school nurture by serving on school wellbeing approach boards of trustees, school wellbeing warning advisory groups, crisis readiness councils, or other school-related essential leadership bodies. What’s more, neighborhood doctors might be approached to counsel on or help with composing school wellbeing related arrangements. School-based screening for vision, hearing, or different conditions may require coordination between nearby doctors and the school attendant to guarantee understudies are alluded for new assessment and treatment, and for correspondence with understudies, families, school organization, and the network. Pediatricians should assume a functioning job in supporting the accessibility and proceeding with instruction of the school nurture. This job may incorporate updates on new AAP suggestions and research discoveries that would keep the school medical attendant’s training as adjusted as conceivable with the ebb and flow AAP arrangement. It is normal that the understudies assume a functioning job in the learning and preparing process amid the clinical courses. The consequences of this investigation unmistakably demonstrated that the nearness of qualified educators in all parts of clinical practice and a steady clinical condition is noteworthy parameters in the instructing and learning procedure of understudies. The outcomes demonstrated that the current instructive framework isn’t working appropriately to exchange learning to the understudies. Along these lines, this framework would require a progression of real changes in the preparation procedure of nursing understudies. Learning Exercises for understudies ought to be performed in a situation where extraordinary learning openings can be experienced. Valuable expert correspondence of the teachers and nursing workforce with the understudies is essential to encourage learning and socialization of nursing understudies. The discoveries of this examination can be utilized in realizing changes in nursing instruction. Like this, it will build the nature of nursing understudies in the patient consideration process. Mindfulness about these variables is useful for the understudies as well. Hence, the progress from understudy stage to turn into a medical caretaker can happen all around rapidly. Reference “Organization for Intensity and Thriving. (2014). Building Better Medicinal Services. Recovered from Http://Www.competeprosper.ca/Transfers/WP20_BetterHealthCare_FINAL.Pdf.” Organization for Intensity and Thriving. (2014). Building Better Medicinal Services. Recovered from Http://Www.competeprosper.ca/Transfers/WP20_BetterHealthCare_FINAL.Pdf. “Bodenheim, T. (2002). Improving Essential Consideration for Patients with Endless Ailment. Diary of the American Restorative Affiliation.” “Walk. S (2011). MDs Can All the More Likely Identify White-Coat Disorder with Mechanized Circulatory Strain Gadgets. Toronto Star. Recovered from Http://Www.thestar.com/Life/health_wellness/2011/03/15/mds_can_better_detect_whitecoat_syndrome_with_automated_bloodpressure_devices.Html.”
Complete ONE reflective clinical journal entry for each clinical day and put in the designated drop box. Your journal article MUST be attached to your assignment. Not submitting your article results
Running head: CLINICAL JOURNAL Reflective Clinical Journal- #1 Reflective Clinical Journal- #1 In this reflective journal, this writer would reflect on her clinical experience by describing the events that was noted. During clinical rotation with the correctional nurse, this student observed certain role the nurses played while they cared for their patients. This journal would also reflect on certain positive areas, knowledge gained, and the areas that were concerning. Finally, this writer would reflect on the research article that evaluating the ways of controlling tuberculosis in prison. Identify the clinical experience and describe the events noting the 4 areas of community Health Nursing: Intake, Chronic Care, Medication Administration, and Episodic Care/Sick Call. This writer was able to observe the intake, chronic care, medication administration, and episodic care process. The intake process involves the processing of a new inmate by the correctional officer. The correctional officer would ask them some set of questions about their physical health, mental health, and history of drug usage and then send the information to the correctional nurses. The correctional nurse then do a quick triage to identify the high risk patient such as those with history of drug usage so that they would be able to closely monitor for withdrawal symptoms. The correctional nurse obtains a health record from an inmate’s primary care provider in other to have access to the medication they are on and to ensure continuity of care. The inmate with history of chronic illness who requires chronic care are seen regularly by the correctional nurse and accessed based on their chronic disease. An example would be to ensure that those who have hypertension have their blood sugar monitored. Medication administration occurs three times a day by the correctional nurse. The correctional nurse goes to administer the meds under a secured and monitored environment in other to ensure the safety of the nurses. The correctional nurse ensures the medication administered is swallowed prior to leaving. This writer was fortunate to see a case of an acute asthmatic attack. The correctional nurse was promptly alerted to see this inmate. The inmate was accessed and then moved to the nursing unit for oxygen to be commenced as well as albuterol. The nurse monitored the inmate until he was stable enough with no difficulty breathing before discharging him back to the unit. This inmate was also educated on ways of avoiding predisposing factors. What was Positive about this experience? This writer learned a lot from observing the facility, the nurses, and the correctional officer. The correctional nurses treated the inmate who had the asthmatic attack with genuine care and kept observing him. The correctional nurse’s also responded promptly to an emergency case during this rotation. What concerns can you identify about this experience? This writer was concerned about the amount of time the correctional nurse had with each clients. The clients had little or no time to express themselves about their health issues making the quality of care delivered minimal. Another concern is the level of confidentiality. This writer felt like the inmates did not have their health information protected or private enough and seemed like the Health Insurance Portability and Accountability Act (HIPAA) did not apply to the inmates. How will today’s experience enhance your knowledge base? This clinical rotation is the first time this writer was exposed to and learning about how health care is delivered in a correctional facility. The writer learned about ways to ensure and maintain safety in this environment and also learned about the management of an asthmatic attack. Finally, this writer gained knowledge about how the healthcare funding of inmate in a correctional facility. Research Article This writer’s research article is on healthy people 2020 and it’s effect on pediatric nurses (Meadows-Oliver & Allen, 2012). Healthy People 2020 are aimed at improving healthy living in the United State. Healthy people 2020 was released in December 2010 and focused on increasing the awareness of determinant of health and the improvement of research and the use of evidence based practices (Meadows-Oliver & Allen, 2012). Several new topics were added to Healthy People 2020 to help achieve health equity and eliminate disparity among children and adolescent. Nurses should make it a goal to improve the health and safety of adolescent in other to prevent accidents and injury, which is known to be the highest killer of individual’s in this age group (Meadows-Oliver & Allen, 2012). According to the article, homicide, suicide, sexually transmitted infection, and unplanned pregnancy are health issues that are common in this group that should be addressed by a community health nurse. While educating adolescent on healthier lifestyle it is important for a nurse to provide an environment of safety and trust in other for the adolescent to be comfortable and be able to open up to the nurse. The article by Meadows-Oliver and Allen (2012) showed a study on adolescents about what they felt about how to improve health and wellness in them and concluded that adolescent viewed attitude, confidentiality, and good communication skills as the key to reach out to adolescent. In other for Healthy People 2020 to meet the objective the community must be involved. A nurse must be aware of this and thus encourage community involvement in other to achieve this goal. In addition to this, a nurse must also set a goal and objectives that must be followed and measured with a specific time frame for Healthy People 2020 to be a reality. Conclusion In summary, this writer did a reflection journal on her first clinical experience in public health. This writer was able to gain from this experience and believes that this would be useful during her nursing career. Finally, this writer is opened to learning more about public and community health nursing during the next clinical day. References Meadows-Oliver, M., & Allen, P. L. J. (2012). Healthy People 2020: Implications for Pediatric Nurses. Pediatric Nursing, 38(2), 101–105. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=104551980&site=eds-live
Complete ONE reflective clinical journal entry for each clinical day and put in the designated drop box. Your journal article MUST be attached to your assignment. Not submitting your article results
PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 261 I n the United States, asthma is the leading cause of morbidity in chil- dren and is presently the most commonly reported cause of school absenteeism, accounting for one-third of all days missed of instruction (Boice, 1998). Educators have recognized that students with serious health needs are at risk for aca- demic failure. School health services personnel play a supportive role for students with asthma through the promotion of wellness, while aiding in achieving adequate asthma control through self-management skills. For students with asthma, the time spent in the health office attending to med- ical needs is often at the expense of classroom instruction, participation in physical education classes, or engagement in social activities. Much of the health care process may depend on the student’s attitude toward absenteeism and his or her perception of the school health per- sonnel as agents of change. The underlying assumption is that school nurses serve as a resource for stress reduction and social support, advo- cate for a trigger-free environment, and are a reliable resource for medical care. The purpose of this study was to compare the relationship between students with asthma to students without asthma regarding attitudes toward school health services, absen- teeism, school nurse support for par- ticipation in extracurricular activities, student academic achievement in mathematics and English, and days absent. as asthma, can be affected in their academic performance when the ill- ness keeps them out of school. Forty- five percent of school-aged children with chronic illness surveyed in a national health interview survey reported to be falling behind in work (35% with failing grades, 36% worry- ing about future employment) (Hoffman, Levy-Shiff, & Ushpiz, 1993). Absenteeism and Teacher Expectations Patterns of increased school absen- teeism are often established early in a child’s academic career and may pose problems in the form of blocks to learning and engagement (Shiu, 2004). Interruptions in lessons and social interaction as a result of time spent for needed treatment are prob- lematic. Hamm (2004) found that absenteeism was higher in asthmatic groups than in others. According to Dockett (2004), chil- dren with asthma are often viewed as being different and physically chal- lenged, and they experience lowered expectations from their teachers. The classroom teacher’s knowledge of asthma may affect the educational experience of students with asthma. Review of the Literature Adolescents with chronic illnesses in school, specifically asthma with all of its physical, social, emotional, and pragmatic challenges, present com- plex problems. Boice (1998) noted that chronic illness in children affect- ed interactions with peers, family, and teachers. Rosina, Crisp, and Steinbeck (2002) reported more problems and concerns with daily living than their cohorts, including suicidal ideations and significantly higher levels of emotional distress. Access to providers can minimize acute situations related to chronic ill- ness. For example, the Agency for Health Research and Quality (AHRQ) Medical Expenditure Panel Survey (Research Activities, 2000) cited the presence of a usual provider as a posi- tive predictor of access to preventive health for adolescents, resulting in reduction in emergency room visits for respiratory illness. For school-aged children, school nurses are in the unique role of provider and advocate, seeing many children with asthma daily. They are in the most opportune position to treat and reduce asthmat- ic triggers and episodes. Children with chronic illness, such Asthma is the most frequent reason for absence from school; it accounts for one- third of all days of missed instruction, placing students at risk for academic fail- ure and social isolation. This study compared high school students with asthma with those without asthma, and examined the relationship of their attitudes toward school health services, absenteeism, academic achievement, and the supposition that school nurse services play an essential part in the academic process. Surveys were completed by all students who participated in the study. Twenty-eight students with asthma reported levels of illness and school nurse support in an additional survey. Data revealed that students with asthma were absent more frequently, scored lower in mathematics, and participated less in school activities than their peers without asthma. Their level of illness did not pre- dict the number of days absent, which was negatively correlated with achieve- ment and positively correlated with students’ permissive attitudes toward absen- teeism. Findings indicate that school nurse interventions were sources of physi- cal, social, emotional, and academic support. Susan Krenitsky-Korn, EdD, FNP, is an Assistant Professor, Division of Nursing, Molloy College, Rockville Centre, NY. High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact On Academic Achievement Susan Krenitsky-Korn 62 PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 2 Educators surveyed reported a lack of knowledge of the disease, as well as lowered academic expectations and pedagogical goals for these students. Children with asthma miss many peri- ods in a day rather than whole days due to medical appointments and treatment in the health office at school, making it difficult to engage in social and academic school activities. Children with poorly controlled asth- ma often have to curtail after-school activities with their peers. Sports activ- ities are interrupted when the need for medication arises in cases of either exercise-induced asthma or due to exposure to environmental triggers, such as pollen and trees surrounding playing fields (Dockett, 2004). School Nurse Support Although research has not sup- ported a correlation of decreased activity participation with perceived peer isolation, depression, or anxiety in children with asthma, participa- tion in activities is an important com- ponent of adolescent development and has been correlated to academic achievement (Everson & Millsap, 2005; Field, Diego & Sanders; 2001; Schreiber & Chambers 2002). School support to maintain active schedules is based on resources and personnel, such as the school nurse. Therefore, understanding the rela- tionships among students with asth- ma factors associated with support in school and absenteeism is important. Perry and Toole (2000) found that school-based programs focusing on increasing parent knowledge of asth- ma result in decreased absenteeism, which has been related to school nurse and case management control of asthma. School health support per- sonnel, such as school nurses, are in an optimum position to influence the student with asthma to participate in sports and non-sports activities. Importantly, students’ attitudes toward health care at school may con- tribute to their ability to participate in school activities. If the school nurse can positively influence the child’s learning environment through reduc- ing asthma triggers and promoting self-management skills, then absen- teeism might be minimized, and par- ticipation can be increased. Studying the relationships among these atti- tudes and characteristics is key. Theoretical Framework Adolescent students need to learn adaptive behaviors as they transition into young adulthood. Health care High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact on Academic Achievement lation from their peers, absenteeism, time spent in the school health office, attitudes about being absent, or the inability to fully participate or engage in academic or extracurricular activi- ties. These issues were central to the surveys developed for the study. Adolescent children with asthma need to attend school, develop skills of self-management, and participate in extracurricular activities to develop cognitively and socially in accordance with similar students in their cohort. Everson and Millsap (2005) found positive relationships with reported life satisfaction, socialization, and participation in extracurricular activi- ties. Physiological and emotional adaptation to all stimuli associated with this illness is essential for a posi- tive learning experience. According to Boice (1998), chronic illness in ado- lescence poses developmental chal- lenges that are magnified. Boice (1998) reported that the creation of school policy concerning asthma, including the creation of daily care plans for nurse management, resulted in decreased reported asthma exacer- bations in school children. This quantitative and qualitative study is an initial step in the investiga- tion of the correlation between the atti- tudes of high school students with and without asthma toward school health services, their days absent, academic achievement, and participation in extracurricular activities. The research questions guiding this study were: How do high school students with and without asthma differ in their attitudes toward school health services, absenteeism, and days absent? issues have been cited as concerns for students in this age group (Brindis, Morreale, & English, 2003; Puskar, Tusaie-Mumford, Sereika, & Lamb, 1999; Saxena, Eliahoo, & Majeed, 2002). Self-management skills are of particular importance in the control of asthmatic symptoms and toward positive outcomes in health promo- tion, as well as disease prevention and management. Access to health care and relationships with health care providers are important factors in achieving wellness for some adoles- cents. Students with asthma may have attitudes toward health services that have an impact on their self- management skills, academic achieve- ment, days absent, and participation in extracurricular activities. Student attitudes toward absenteeism, aca- demic engagement, and support for participation in extracurricular activi- ties may relate to interactions and advocacy from school health services. This study applied concepts from adolescent developmental and nurs- ing systems theories in relation to the adolescent with asthma (see Figure 1). The theoretical framework developed by Sr. Callista Roy (2000) formed the base. According to Roy, Pollock, and Massey (1999), a person’s adaptation level is a constantly changing point. Asthmatic episodes or impaired breathing often occur as a result of stimuli or input, also called triggers, into the respiratory system from the environment. The child’s level of ill- ness, emotional-social status, and cog- nitive abilities will affect the outcome of the episode depending on the con- trol or coping processes in place. This in turn results in increased social iso- Figure 1. Adolescent Development and Chronic Illness Level of Asthmatic Condition Attitudes toward health services Academic achievement Days absent Participation in extracurricular activies Adolescent developmental stage Input Stimuli Adaptation level Effectors Physiological function Self concept Role function InterdependenceControl Process Coping mechanism Regulator Cognator Output Adaptive response Ineffective response PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 263 What relationship is there among attitudes of students with and without asthma toward school health services, absenteeism, and school nurse support for partici- pation in extracurricular activi- ties? Does gender affect attitudes toward school health services, absenteeism, and participation in extracurricular activities, and their achievement in mathemat- ics and English? One open-ended question was added: How do students with asthma describe their school nurse’s help in managing their asthma on three open-ended questions? Methodology This study used a non-experimen- tal mixed method design that com- bined a survey approach with school attendance and academic records. Sample A convenience sample (N= 57) of students with and without asthma in a suburban high school were selec- tively chosen and matched by gender and existence of asthma (on the school record) for the study. The high school studied was composed of a diverse population of 1176 students (591 females and 585 males). The school demographics were 77% Caucasian, 8% African American, 11% Hispanic, 3% Asian, and 1% Native American. The students were primarily from two-parent, middle class families, with a small number of students from lower economic public housing. Most students had access to private health care. Sixty-seven stu- dents with asthma have participated in a sports activity within the past school year. Ninety-seven high school students in grades 9 through 12 were identified through their cumulative health and medical records as having been med- ically diagnosed, self-reported, or par- ent-reported, with chronic, seasonal, exercise-induced or cough-variant bronchial asthma. Additionally, 97 purposefully selected students with no report of asthma were matched by gender and grade level to the students with asthma. Of the 194 students who were invited to participate in the study, 57 students and their parents agreed to participate (28 with asthma and 29 without asthma). There were 33 females and 24 males who partici- pated in the study. This represented 30% of the invited population.School Nurse Support:Students’ attitudes toward the school nurse’s and the school health aide’s ability to meet their indi- vidual needs. School Nurse Interventions for Participation in Extra-Curricular Activities:School nurse support and interventions that help stu- dents participate in a school- sponsored club, inter-scholastic sports activity, or performance groups. Students with asthma were identi- fied as having the medical condition noted on the student cumulative health records or physical examina- tion. Level of illness with asthma was defined and classified by the National Asthma Education Program (1997) to be mild intermittent, mild persistent, moderate persistent, and/or severe persistent and self-reported impact of illness on activities and life style (self- reported). Students with asthma were afforded the opportunity to complete an additional survey concerning their level of illness. Levels of illness were determined through an analysis of student responses to an adaptation of a national survey supported by the American Lung Association (Quality Metric, Inc., 2002) and addressed the research problems in this study. There were 10 questions to measure level of asthmatic illness, with a score range of 10 to 50. These 10 additional ques- tions assessing level of illness were administered only to students with asthma (α= 0.87). The survey for these students consisted of three addi- tional open-ended questions concern- ing their relationship with their school nurse. Data Collection Method After Institutional Review Board and school administrative approval, the study was conducted. Participants were invited to a designated office, one at a time, where surveys were dis- tributed and completed. Additional data included school attendance records and final academic scores in English and mathematics obtained from the previous academic year. Research questions guided this study by comparing attitudes, absentee rates, achievement, and participation in extracurricular activities in both students with and without asthma according to gender, condition, and school nurse support. For students with asthma, level of illness was con- sidered. Measures Both groups of students were given the student Survey on Health Services in My School (SHSMS) to assess their perceptions of health services in their school and report of participation in extracurricular activities. The survey was developed for the study with reported factor analysis and reliability of the variables (Coefficient alpha range: r = 0.72 to r= 0.87, except for “attitude about absenteeism” r= 0.60) (Krenitsky, 2006). It consisted of 26 items that measured attitudes toward school health services, absenteeism, comfort with school nurse services, school nurse intervention with extracurricular activities, and school nurse support. A five-point Likert scale with values of 1 = never, 2 = hardly ever, 3 = sometimes, 4 = often, and 5 = always, was used for the quan- titative analysis. The files were split into two groups of students with and without asthma for comparison. Asthma was defined as a written med- ical diagnosis documented on the stu- dent’s health record. The dependent variables in this study were the final grades in mathe- matics and English (based on the state required courses at that level for all students) and days absent. Independent variables included atti- tudes toward school health services, absenteeism, and support for partici- pation in extracurricular activities. The following definitions and terms were used in this study as dependent variables: Days Absent: Attendance records that reflect more than three peri- ods of missed school for the 2004- 2005 school year measured in days. Academic Achievement:Final grades achieved in mathematics and English (Gillock & Reyes, 1999; Shiu, 2004) for students in the 9th through 12th grades measured as a numeric grade. The following terms and defini- tions related to attitudes were used as variables in this study and measured on the survey: Absenteeism: Permissive attitudes toward missed days of school, time spent in the health office, and missed instruction time. Comfort with School Nurse Services: Students’ attitudes toward school nurse responsiveness, communi- cation, and ease of accessing health care. School Health Services:Students’ attitudes toward the role of the school health team with their health care. 64 PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 2 High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact on Academic Achievement Results Attitudes Toward School Health Services and Absenteeism, and Days Absent Responses from the majority of students indicated they were aware of the school nurse’s presence in the building, and reported comfort in receiving treatments in the health office. Furthermore, 65% of the stu- dents surveyed denied ever going to see the nurse to get out of class. Regarding their attitudes toward absenteeism, most students reported they did not feel they stayed home from school more than others in their grade. Both students with and with- out asthma reported that sometimes the school nurse answered questions about their health and contributed to helping them make it through the day when they did not feel well. Overall, students with asthma were absent from school more often than students without asthma (t = 2.65, p < 0.05); there were no significant differ-ance groups, except for school-spon- sored clubs where females generally participated at a higher level (χ 2= 12.48, p< 0.01). The males without asthma tended to participate more than males with asthma in school- sponsored sports (see Table 2). There was also a difference, al – though not significant, between stu- dents with and without asthma will- ing to be absent (F= 3.69, p= 0.06), and a significant difference in atti- tudes about school health services (F = 21.41, p < 0.01) (see Table 3). Females with asthma were more will- ing to be absent than females without asthma (t= 2.58, p< 0.05). For stu- dents with asthma, females were more willing to be absent than males (t= 2.51, p < 0.05). Attitudes Toward School Health Services, Absenteeism, And Extracurricular Activities The willingness to stay in school was similar in both groups; students reported hardly ever wishing to be absent. Students with asthma report- ed hardly ever missing extracurricular activities due to school nurse assis- tance, which was slightly different than their counterparts without asth- ma who experienced this some of the time. Whereas 47% of all respondents with and without asthma often per- ceived the school nurse as providing services that helped them “make it through the day,” only 29% felt the nurse helped them participate in extracurricular activities when they did not feel well. Despite no significant differences between attitudes of students with and without asthma toward school nurse interventions with extracurricu- lar activities, the cohort with asthma reported more teacher complicity in their missing work due to illness in response to: “My teacher permits me to miss assignments…due to illness.” A similar pattern was seen in overall participation and school health serv- ices support to clubs and participation in performance groups. Although only 26% of the students saw the nurse as a person who advocates for them and as a school official who would help them manage their illness or participate in activities and sports, 37% were aware that the nurse often communicated with teachers, advi- sors, and coaches when they were not feeling well. Although both groups of students reported they sometimes go to the health office for help when needed, students with asthma tended to report receiving more help with ences in days absent between gender for both groups of students (p = NS) (see Table 1). Attendance records revealed that students with asthma stayed home twice as often as stu- dents without asthma. When asked if they thought they stayed home more than others in their class, students with asthma perceived this to be true although not statistically significant (see question 13; p = 0.08). For both groups, there was no relationship between school nurse support and their days absent (students with asth- ma r = 0.27, p= NS; students without asthma r= 0.35, p= NS). Participation and Absence By Gender and Asthmatic Condition There were differences by gender and asthmatic condition in students reported participation in clubs, sports, and performance groups. Survey responses indicated that patterns of participation by gender were similar for both groups of students in perform- Table 1. Mean Comparisons for Asthma/Non-Asthma and Days Absent *Question 13: “I stayed home from school more than students in my grade.” Days absent (asthma/non-asthma): t= 2.65, p < 0.05 Question 13 (asthma/non-asthma): t = 1.69, p = 0.08 Days absent (gender): t= 0.91, p = NS Days Absent Self-Report Quest 13** Mean SD Mean SD Condition* Asthma (n = 28) 12.6 11.7 1.9 1.2 Non-asthma ( n = 29) 6.2 5.0 1.4 0.8 Gender Males ( n = 24) 7.8 6.3 Females ( n = 33) 10.2 10.9 Clubs (Asthma – Male/female) χ 2= 12.48, p < 0.01 Sports (Males – Asthma/non-asthma) χ 2= 8.97, p < 0.01 Table 2. Participation Levels for Students with and without Asthma Club Sports Performance Group Asthma Males 58% 54% 33% Females 81% 50% 50% Non-Asthma Males 75% 33% 83% Females 82% 35% 53% PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 265 their medical problems. Fifty-six per- cent of both groups of students reported a high comfort level with their school nurse and with commu- nications regarding their own health issues. Conversely, 26% of the stu- dents saw the nurse as a facilitator in the process of independent health decision making. Students without asthma experienced a stronger rela- tionship between school nurse inter- ventions in extra-curricular activities and comfort with school nurse servic- es. However, days absent were not related to students’ sense of comfort with health services, and attitudes toward health support services had no relationship with days absent for stu- dents with asthma (r= 0.12, p= NS) and those without (r = 0.06, p= NS). Both groups were equally aware that the school nurse was available for services daily and were comfortable taking treatments when needed in the school health office. tudes toward absences tended to be absent more often in math and English (r= -0.61, p< 0.05; and r = -0.58, p < 0.05), respectively. Students without asthma exhibited the same negative correlation between attitudes toward absences and days absent, but the cor- relation was non-significant. Whereas students with asthma were absent twice as much as students without asthma, for those with asthma, none of their attitudes toward school health services predicted their days absent when their level of illness was employed as a moderating variable. Further, when their level of asthma control was low or their level of illness high, there was no correlation to their number of days absent. Asthmatic Students’ Perceptions of School Nurse Support Analysis of the open-ended ques- tions revealed that students tended to Absenteeism and Academic Achievement Attitudes about being absent were the most important variable to being absent and resulting academic achieve- ment. The more positive their attitudes were toward absenteeism (the more willing the students were to being absent), the more actual days absent (asthma r= 0.61, p< 0.05; non-asthma r= 0.37, p = 0.05). Achievement in mathematics was affected by a nega- tive relationship with days absent in both groups. Comparing academic achievement in mathematics and English between students with asthma and those without, lower mathematics scores were evidenced in both groups where rates of absenteeism were high- er. Students with asthma had higher rates of absence and demonstrated lower scores in mathematics and English grades (see Table 4). Students with asthma who held positive atti- * Absenteeism: F= 3.69, p = 0.06 Note: Females absenteeism (asthma/non-asthma): t= 2.51, p< 0.05 Asthmatic absenteeism (male/female): t= 2.61, p < 0.05 Males absenteeism (asthma/non-asthma): t= 0.263, p= NS **Attitudes about school health services: F= 21.41, p < 0.05 Note: Asthmatics’ attitudes school health services (male/female): t= 3.42, p< 0.05 Non-asthmatics’ attitudes school health services (male/female): t= 5.02, p < 0.05 ***Comfort with school nurse services Note: Asthmatics’ comfort with school nurse services (males/females): t= 3.84, p < 0.01 Table 3. Mean Differences Between Attitudes of Students with and without Asthma by Gender Gender Absenteeism (Willingness to Be Absent)* Mean SD Attitudes About School Health Services** Mean SD Comfort with School Nurse Services*** Mean SD School Nurse Intervention with Extracurricular Mean SD School Nurse Support Mean SD Asthma (n = 28) 6.76 17.69 9.61 10.62 7.42 2.38 3.96 0.73 2.94 2.01 Males (n = 12) 5.60 20.50 9.83 12.25 7.58 1.55 3.83 0.83 2.65 1.24 Females (n= 16) 7.50 15.93 9.43 9.81 7.31 1.95 2.97 0.89 2.80 2.46 Non-Asthma (n= 29) 6.07 16.48 9.17 9.92 7.17 1.92 4.64 1.13 3.38 2.03 Males (n = 12) 5.81 19.45 9.08 9.63 7.41 1.94 4.22 1.16 4.17 2.53 Females (n= 17) 6.23 14.43 9.23 10.11 7.00 0.73 3.81 1.16 2.89 1.65 66 PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 2 High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact on Academic Achievement respond positively with health servic- es, school nurses, and health interven- tions. Several positive comments noted the availability of health care interventions; provision of health care services to manage medications; pro- visions of a site for emotional support and relaxation; positive communica- tions and interventions with teachers, parents, and private physicians; encouragement to stay in class and school or to participate in activities; and self-management of asthma. Most comments revolved around school nurse services in the health office. Many of the students with asthma who responded to the open-ended questions expressed that the availabil- ity of the nurse to respond to their needs in an emergency and provide rest and comfort for them was impor- tant. A typical source of help for the students was in the expedient accessi- bility of their inhalers when needed. Still others indicated that the ability to self-mange their own asthma limit- ed their actual contact with the school nurse. Appreciation of health office communication with their par- ents, physicians, teachers, coaches, and advisors concerning their condi- tion and treatments was frequently expressed. Of the students with asth- ma who joined in athletic activities, many indicated that school health office assistance in providing physical examinations and clearing them to participate was appreciated. A great number of students noted that inter- ventions and encouragement to stay in or return to classes after treatment for their asthma assisted them in their academic classes and kept them focused, missing a minimal amount of schoolwork. Importantly, the nurse’s awareness of their need for prolonged stay in the health office, based on severity of acute episodes of their asthma, was praised frequently.health services must have an open and inviting culture if students are to use these services. However, one must draw the cautionary inference that students may perceive supportive health service as helpful ways to excuse class absences; such assump- tions within the student culture war- rant constant vigilance and further study. Because students who demonstrat- ed a willingness to stay in school were absent less despite their asthma, cor- relations to a supportive school policy were made. Thus, allowing for self- treatment when and where needed fosters self-management skills to con- trol chronic illness through expedient and preventative treatment. This school must find appropriate inter- ventions for students with asthma to reduce their loss of instructional time as well as gaps in sequential learning events created by their absences. When students’ level of asthma control was low, or level of illness high, there was no correlation to their number of days absent, which was of interest. This may indicate that other influencing factors particular to their learning environment not measured in this study contribute to their level of absence. School officials need to address the issue of permissive attitudes toward absence with parents and students. Because permissive attitudes toward absence were highly related to higher absences and low grades for students with asthma, the school pupil person- nel team should address the cultural beliefs about absences among staff, students, and parents. A contributing factor in these results may be attrib- uted to the large numbers of students, who through parental and physician consent in accordance with school policy, self-manage their illness through the use of their inhalers apart from the school health office. Contrarily, individual severity of chronic illness as it relates to students excusing themselves from all activi- ties may not be known to the nurse. In addition, school attendance policy does not require extensive explana- tions of reasons for absences other than parent report of illness. A school policy that required more precise rea- sons for absence would enable the school health services to better moni- tor student absences. The results of this study were limit- ed to one suburban high school in the metropolitan New York City area. The following factors represent additional constraints on the outcomes of the Discussion This study supported Shiu’s (2004) research correlating asthma and absenteeism as a block to learning. Because mathematics is taught as sequential curricula, and learners are more sensitive to missed instruction days than in less sequential curricula, students with asthma may be at greater risk for failure unless the school adopts appropriate academic interventions for students with chronic illnesses. In sports activities, less participa- tion rates in students with asthma may be related to difficulties in mak- ing intensive practice schedules and general endurance. Despite varied responses, overall, few students admitted to wanting to be absent from school, classes, or activities. The gender-based patterns should be monitored and further investigated to ensure that all students take advan- tage of the opportunities available at this school for academic, social, and health-related successful self-manage- ment. These students reported a strong relationship with comfort with school nurse services and interven- tions in their extracurricular activities in their comments about school health office personnel facilitating their medical reports, physicals for sports, and other elements in the school participation process. It appeared that when the school nurse encouraged students to return to activities or class even when they were not feeling well, they were more likely to be treated and attend classes. Stays in the health office and likeli- ness to go home were less. Availability of treatment, such as inhalers, and subsequently allowing short periods of rest and relaxation afterward were indicated as positive sources of school nurse support and comfort. School Note: Only reports for complete data. Table 4. Mean Comparisons for Achievement in Mathematics and English Academic Achievement Mean SD t p Mathematics 1.99 0.05 Asthma ( n = 26) 84.2 8.7 Non-asthma ( n= 26) 88.6 7.2 English 0.59 NS Asthma ( n= 27) 89.3 7.2 Non-asthma ( n = 28) 90.3 5.2 PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 267 study: 1) a purposeful sample of high school students to carefully focus on children with and without asthma, 2) the small sample size due to the method selected using direct inter- views of the children with asthma, 3) the inability to control for other chronic illnesses and medical condi- tions other than asthma in the sam- ple of high school students, and 4) the researcher, who was a nurse prac- titioner serving as a school nurse teacher in the school district studied, conducted the interviews. This limita- tion, however, was a strength in the ability to obtain the sample and con- sents, and carry out the study with a familiar interviewer. Future studies that minimize inherent limitations in methodology and sample using a wider range of school districts and controlling for intervening variables need to be developed. Implications for School Nursing Practice School nurses have a distinct role in contributing to the academic engagement of all students. Borowsky (2005) concluded that school nurses, by the nature of their frequent con- tact with students with asthma, were in the unique role of providing them with both physical and emotional support. Apart from exacerbations of high levels of illness, secondary stu- dents tend to be more independent of school nurse services and are less in need of everyday monitoring than elementary students. Further investi- gation is needed to determine the nature of the relationship of the school nurse and individual student needs other than for medical treat- ment. Dockett (2004) discussed the impact of school nurse communica- tion with other school personnel on adolescents with asthma as a means of stress reduction and increased self- esteem in asthmatic students. School nurses should continue to develop effective communication techniques when developing plans of care. The school nurse may be an advocate for students with asthma, encouraging and assisting them in participation in extracurricular activities via provision of the needed communication prac- tices other than formal memos to and from school officials, coaches, teach- ers, advisors, and parents. Research concerning school nurse provision of asthma education to administrators and staff is needed to benefit students and address the nature of individual absenteeism and teacher complicitydepth evaluation of economic status and student access to health care out- side of school may be beneficial. The school nurse as a case manag- er, provider of treatments, and facili- tator for the process of sports partici- pation and other activities plays an important role for the student with asthma. Although school health serv- ices remained a conscious source of support for approximately one-third of the students, school health office communication practices should be evaluated in terms of student advoca- cy. Expanding the role of school health services for adolescents may provide the needed support for adap- tive emotional and physiological responses in the presence of chronic illness. ReferencesBigby, L.M. (2004). Medical and health-relat- ed services: More than treating boo- boos and ouchies. Interventions in School and Clinic, 39(4), 233-235. Boice, M. (1998). Chronic illness in adoles- cence. Adolescence, 33 (132), 927-941. Borowsky, B. (2005). Asthma prevalence in school-aged children on Long Island. Paper presented April 13, 2005, at the meeting of the Asthma Coalition of Long Island, 2005, Melville, NY. Brindis, C.D., Morreale, M.C., & English, A. (2003). The unique health care needs of adolescents. The Future of Children, 13 (1), 117-135. Dockett, S. (2004). “Everyone was really happy to see me!” The importance of friendships in the return to school of children with chronic illnesses. Australian Journal of Early childhood, 29(1), 27-32. Everson, H., & Millsap, R. (2005). Everyone gains: Extracurricular activities in high school and higher SAT scores. College Board Research Report No, 2005-2: College Entrance Examination Board. Retrieved from http://professionals.col- legeboard.com/profdownload/pdf/1168 cbTEXTv2.pdf Field, T., Diego, M., & Sanders, C.E. (2001). Exercise is positively related to adoles- cents’ relationships and academics. Adolescence, 36 (141), 105-110. Gillock, K., & Reyes, O. (1999). Stress, sup- port, and academic performance of urban, low-income, Mexican-American adolescents. Journal of Youth and Adolescence, 28(2), 259-282. Hamm, E. (2004). Managing asthma in the classroom. Childhood Education 8 (1), 16-23. Hoffman, M.A., Levy-Shiff, R., & Ushpiz, V. (1993). Gender differences in the rela- tion between stressful life events and adjustment among school-aged chil- dren. Sex Roles. A Journal of Research, 29 (7-8), 441-455. Krenitsky, S. (2006). Asthmatic and non- asthmatic high school student attitudes toward school health services, absen- with absences. The school nurse and attendance office should more thor- oughly investigate students’ reasons for absence and explore levels of asth- ma control based upon criteria estab- lished by the National Heart, Lung, and Blood Institute (2002). As Taras, Wright, Brennan, Campagna, and Lofgren (2004) reported, school nurse case management resulted in decreased asthma severity and fewer absences; comfort with school nurse services may result in less asthmatic episodes and less instruction time missed. Nurses need to encourage stu- dents to avoid missing school and decreasing time spent in the health office, and thus, remaining academi- cally engaged (Taras & Potts-Datema, 2005; Theis 1999). In accordance with Bigby (2004), nurses have an important role in advocacy and support to ensure that students with asthma attend school in an atmosphere conducive for learn- ing and receive assistance in asthma management. School nurse case man- agement and education, as supported by the literature, are considered as sources of empowerment for nurses and their students with asthma (Perry & Toole, 2000). Additionally, the school might consider facilitating schedules for the school nurse to meet with students in their science and health classes to discuss health-relat- ed issues and proper self-management of school obligations and personal health. Through a team approach of staff development, school administra- tive policy, and supporting student self-management skills, this objective may be achieved. Additionally, the health office needs to be aware of any inconsistency in reported reasons for asthmatic absences that may be attributed to multiple factors, includ- ing parents’ perception of illness, physician management plan, and socioeconomic level. School nurse assistance in the control of asthmatic episodes of school children may be contingent upon the inhibition of the asthmatic response through the con- trol of triggers from environmental substances and stress reduction, as well as monitoring and providing treatment expediently. It is important to determine and correlate the need for school health services for students with chronic ill- ness by their number of co-morbidi- ties. Nurses should include parents and significant others to further investigate the effect of illness on social interaction to understand the impact of this chronic illness on ado- lescent quality of life. Including an in- 68 PEDIATRIC NURSING /March-April 2011/Vol. 37/No. 2 High School Students with Asthma: Attitudes about School Health, Absenteeism, and Its Impact on Academic Achievement teeism, comfort with school nurse services, school nurse intervention in extracurricular activities, school nurse support and their days absent and aca- demic achievement (Doctoral Dis ser – tation, Dowling College, 2006). Pro – Quest Information and Learning Company UMI 3222566. National Asthma Education Program. (1997). The expert panel reports 2: Guidelines for the diagnosis and management of asthma. (NIH publication #97-4051). Bethesda, MD: Author. National Heart, Lung & Blood Institute. (2002). How friendly is your school sur- vey.Retrieved from www.nhlbi.nih.gov/ health/public/lung/asthma/sch_chk.htm Perry, C.S., & Toole, K. (2000). The impact of school nurse case management on asthma control in school-aged children. The Journal of School Health, 70 (7), 303-304. Puskar, K.R., Tusaie-Mumford, K., Sereika, S., & Lamb, J. (1999). Health concerns and risk behaviors of rural adolescents. Journal of Community Health Nursing, 16(2), 109-119. Quality Metric, Incd. (2002). Asthma control test . Retrieved May 9, 2005, from http://www.asthmacontrol.com Research Activities. (2000). AHRQ medical expenditure panel survey . Rockville, MD: U.S. Department of Health and Human Services Agency for Healthcare Research and Quality.Taras, H., Wright, S., Brennan, J., Campagna, J., & Lofgren, R. (2004). Impact of school nurse case manage- ment on students with asthma. The Journal of School Health, 74 (6), 213- 219. Theis, K. (1999). Identifying the education implication of chronic illness in school children. Journal of School Health, 69 (10), 392-397. Additional ReadingsBoston College, William F. Connell School of Nursing. (2003). The Roy adaptation model . Retrieved from http://www.bc. edu/schools/son/faculty/featured/theo- rist/Roy_Adaptation_Model.html Buckner, E.B., Hawkins, A. M., Stover, L., Brakefield, J., Simmons, F.C., Payne, S., … Dubois, G. (2005). Knowledge, resilience, and effectiveness of educa- tion in a young teen asthma camp. Pediatric Nursing, 31 (3), 205-208. Evans, T. (2004). A multidimensional assess- ment of children with chronic physical conditions. Health and Social Work, 29 (3), 245-252. Seiffge-Krenke, I. (1998). Adolescent’s health: A developmental perspective . Mahwah. NJ: Lawrence Erlbaum Associates. Rosina, R., Crisp, J., & Steinbeck, K. (2002). Treatment adherence of youth and young adults with and without a chronic illness. Nursing and Health Sciences, 5 (12), 139-147. Roy, C. (2000). The visible and invisible fields that shape the future of the nursing care system. Nursing Administration Quarterly, 25(2), 1-12. Roy, C., Pollock, S.E., Massey, V.H. (1999). Roy adaptation model based research: 25 years of contributions to nursing sci- ence. Indianapolis, IN: Sigma Theta Tau International. Saxena, S., Eliahoo, J., & Majeed, A.(2002). Socioeconomic and ethnic group differ- ences in self-reported health status and use of health care services by children and young people in England: Cross- sectional study. British Medical Journal, 325 (7363), 520. Schreiber, J., & Chambers, E. (2002). After- school pursuits, ethnicity and achieve- ment for 8th and 10th grade students. The Journal of Educational Research, 96(2), 90-112. Shiu, S. (2004). Maintaining the thread: Including young children with chronic ill- ness in the primary classroom. Australian Journal of Early Childhood, 28(1), 33-38. Taras, H., & Potts-Datema, W. (2005). Childhood asthma and student perform- ance at school. Journal of School Health, 75 (8), 296-312. Copyright of Pediatric Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use.