An investigation of school playground safety practices as reported by school nurses.

The purpose of this study was to investigate school playground safety practices. The study used a purposeful sample of school nurses who attended a playground safety workshop at the 2006 National Association of School Nurses annual conference. Seventy-five questionnaires were distributed, and 64 useable questionnaires were returned. The responses indicated that little attention is being given to providing safe playground environments in schools as measured by best practices of supervision, age-appropriate design, fall surfacing, and equipment maintenance. Participants pointed to the need for better supervision and supervision training, careful selection of age-appropriate equipment, maintaining adequate fall surfaces under the equipment, and ensuring that equipment is properly maintained and repaired. The study also revealed that school nurses believe they could play a role in playground injury prevention through the collection and analysis of injury data, communication to administrators about the need for comprehensive planning of the play environment, and becoming active members of playground safety committees.     

Developing a playground injury prevention plan

Playgrounds are a major source of unintentional injuries in the school environment. In fact, 80% of all injuries on public playground equipment happen at school. Thus, the need for developing a playground injury prevention plan is critical to provide safe educational outdoor environments for children. The S.A.F.E.trade mark framework for injury prevention is the first step in preventing playground injuries. This article highlights suggestions that school nurses can implement in creating an effective playground injury prevention program at their schools.     

Current clinical research on type 2 diabetes and its prevention in youth

The SEARCH, TODAY, and HEALTHY studies, and NASN's SCOPE intervention, illustrate that collaboration between schools, school nurses, clinicians, students, and families can help treat and prevent diabetes and obesity in youth. Findings will help identify the prevalence of diabetes in young people, the best ways to treat youth with new-onset type 2 diabetes, and healthful practices that can reduce risk factors for cardiovascular disease. Findings about diabetes prevention in the school setting can guide school nurses and school leadership to incorporate effective changes into food and physical activity offerings to students. Finally, school nurses can communicate with primary care providers and provide culturally sensitive letters to parents and guardians regarding the BMI results for the child.     

Strangulation injuries in children

In this article we present a case of fatal strangulation with playground equipment in a 4-year-old child and a review of the literature. Playground injuries are a major cause of injury in children but fatalities are rare. However, strangulation is the cause of death in more than 50% of all playground fatalities. Neurological damage and death are caused by airway obstruction and venous congestion leading to hypoxia, acidosis, brain congestion and brain cell death. Airway injury in survivors is an exception and spinal cord injury has not been found in survivors. The mortality rate in strangulation is high. In cardiac arrest survival is unlikely and full neurological recovery has never been reported. However, all resuscitative efforts should be undertaken in patients with a residual circulation because neurologically intact survival is possible even in deeply comatose patients.     

Planning playgrounds for children with disabilities

Occupational therapists are well qualified for involvement in playground planning. They know how to eliminate architectural barriers, adapt equipment to maximize independence and functional levels, and use play in facilitating children's development. By participating in playground planning or adaptation, the occupational therapist can present play opportunities for children with disabilities, increase public awareness of occupational therapy, and extend the use of treatment modalities. This paper makes specific suggestions for planning and building to make the idea for a playground a realistic goal. A case example illustrates the planning of a playground in a hospital setting.     

Surgical count practice variability and the potential for retained surgical items

Validating existing count practices and reducing individual practice variance are necessary to decrease the risk for retained surgical items. A quality improvement project was undertaken at one large city hospital to identify best practice and eliminate variability in count practices. The project included an analysis of 20 surgical count policies from hospitals across the country and a review of count practices among nurses and surgical technologists at the facility. Assessment of the policies and practices indicated that clinical practice requirements in the policies varied greatly, and there was a high degree of count practice variability among staff members. The facility OR manager and OR quality coordinator collaborated with staff nurses and surgical technologists to identify practices that created variability and then addressed each one to create a new count policy and reduce the risk of retained surgical items.     

Marginalization and school nursing.

The concept of marginalization was first analyzed by nursing researchers Hall, Stevens, and Meleis. Although nursing literature frequently refers to this concept when addressing "at risk" groups such as the homeless, gays and lesbians, and those infected with HIV/AIDS, the concept can also be applied to nursing. Analysis of current school nursing literature and research suggests school nursing may be a marginalized specialty, encompassing many of the characteristics of marginalization including isolation, role confusion, and barriers to practice. School nurses can reduce or eliminate these characteristics by increasing their visibility and collaborative opportunities in the educational and nursing communities while also providing mentoring opportunities to new school nurses.     

School nurses' support for bereaved students: a pilot study.

Children may have difficulty with schoolwork because of grief over the death of an important person in their lives. School nurses provide support to these children. This pilot study consisted of a Web-based survey completed by 6 school nurses in a 3-county area in Washington state. The purpose of this pilot study was to assess the need for additional support for bereaved children and the extent to which school nurses meet the needs of these students. Results indicated that many school nurses have large caseloads that preclude spending as much time with bereaved students as the nurses feel is necessary. Bereaved students exhibit a wide variety of grief symptoms that may interfere with learning. In addition, rural areas do not have adequate community bereavement resources that nurses can use to refer students who need help beyond that offered at school. Nurses must be more active in supporting students within the school setting despite limited resources.     

NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry

Healthcare workers, including orthopaedic nurses, face a number of risk factors in the workplace for musculoskeletal disorders such as back and shoulder injuries. These disorders are associated with excessive back and shoulder loading due to manual patient handling, applying excessive forces during pushing and/or pulling of objects, required use of awkward postures during patient care, and working long hours and shiftwork. No healthcare workers are immune from injury because workers in all clinical areas are exposed to occupational risk factors, including hospitals, nursing homes, emergency services, critical care, operating rooms, orthopaedic units, and home healthcare environments. This article includes a summary of the scientific efforts of the researchers and their partners at the National Institute for Occupational Safety and Health (NIOSH) in evaluating and developing the best practice recommendations for reducing risk of these disorders for exposed workers. The studies conducted by NIOSH researchers and their partners approach the problem from a variety of perspectives, ranging from comprehensive epidemiological studies examining the effectiveness of implementation of a safe patient handling and movement program to laboratory studies evaluating the biomechanical stress associated with using patient handling equipment, and education training programs for use in schools of nursing to educate new workers about safe work practices. Results of these studies have provided scientific evidence that significant occupational risks for musculoskeletal disorders exist and that effective interventions are available to reduce the risk for these workers.     

School nurses' perceptions of self-efficacy in providing diabetes care.

The purpose of this study was to measure school nurses' perceived self-efficacy in providing diabetes care and education to children and to identify factors that correlate with higher self-efficacy levels in the performance of these tasks. The results of this study revealed that the surveyed school nurses perceived a moderate level of self-efficacy in providing diabetes education. Significant findings in this study were positive relationships between self-efficacy and 3 variables: (a) participating in the care of children with diabetes, (b) having type 1 diabetes children in the school system, and (c) supervising children with blood glucose meter testing. There was a significant relationship between higher self-efficacy scores and having a diabetes curriculum. However, only nine school nurses reported having a diabetes curriculum. School nurses can benefit by understanding what factors increase self-efficacy related to diabetes education designed to enhance school-age children's knowledge of diabetes and its management.     

Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint

Restrictive practices continue to be used in mental health care despite increasing recognition of their harms and an international effort to reduce and ultimately eliminate their use. The aim of this qualitative study was to explore mental health nurses’ views of the potential elimination of these practices. Nine focus groups were conducted with 44 mental health nurses across Australia, and the data analysed using thematic analysis. Overall, the nurses expressed significant fear about the potential elimination of restrictive practices and saw themselves as being blamed for both the use of these practices and the consequences should they be eliminated. Findings detail the conflicts facing staff in balancing the need for ward safety for everyone present while at the same time providing person‐centred care. Nurses described the changing role of the mental health nurse in acute settings, being more focussed on risk assessment and medication while at the same time attempting to practise in trauma‐informed person‐centred ways. The impact on ward safety with increasing acuity of consumers plus the presence of forensic consumers and those affected by methamphetamine was emphasized. Change initiatives need to take into account nurses’ deep concerns about the consequences of eliminating all forms of control measures in hospitals and respond to the symptoms and behaviours consumers present with and associated unpredictable and concerning behaviours. Attempts to eliminate restrictive practices should, therefore, be carefully considered and come with a clear articulation of alternatives to ensure the safety of consumers, visitors, and staff.     

School nurses and sex education: surveillance and disciplinary practices in primary schools

Title. School nurses and sex education: surveillance and disciplinary practices in primary schools Aim. This paper is a report of a study to explore how school nurses perceive the influence of schools on their role in delivering sex and relationship education in primary schools. Background. School nurses play a key role in sex education in English schools. However, sex education is a contentious issue meaning the sex education of children is often an area of tension within the curriculum. However, the impact of these tensions upon school nursing practice is poorly described. Method. Three focus groups with a convenience sample of 16 nurses experienced in conducting sex and relationship education were conducted during 2006. Focus groups were audio‐taped, transcribed verbatim and subjected to a thematic analysis. Findings. Four themes were identified in the data: ‘covert surveillance’ refers to school staff conducting clandestine surveillance of the classroom actions of the nurse; ‘overt surveillance’ reflects how nurses felt they were being openly monitored by teachers in the classroom; ‘Teacher attitude’ refers to the interventions of the supervising teacher in the classroom during the sex education session and ‘resistance practices’ detailed how nurses attempted to manage the disciplinary practices of the school. Conclusion. School nurses need to be pragmatic about the fact that there will be some attempts by the school to regulate sex education. Developing an early dialogue with the school can mediate this. Closer working practices and the involvement of school nurses in the development of sex education policy and practice is vital to ensure that they continue to make a valuable contribution to sex education in schools.     

Occupational health and school health: a natural alliance?

BACKGROUND: The United Kingdom National Health Service aims to provide a holistic 'cradle to grave' service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly-stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime. AIM: This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services. DISCUSSION: The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined. CONCLUSION: We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers.     

Taking steps to control costs in the OR

Hospitals continue to be challenged by rising expenses in an environment of moderate reimbursements. Health care costs have increasingly come under scrutiny and, with the advent of health care reform, will continue to be scrutinized. Perioperative nurses play a key role in evaluating product safety, effectiveness and efficiency, environmental concerns, and cost and how these factors affect patient care. Cost-saving opportunities that a hospital product evaluation committee can consider include choosing less expensive but equivalent supplies, comparing the expenses associated with disposable versus reusable products, limiting the use of custom supplies, determining ways to reduce linen use, and changing practices to eliminate products that are found to have little clinical value. Adopting effective product evaluation and purchasing practices can lead to reduced costs without affecting the quality of patient care.     

Development of a skin cancer prevention program.

The Centers for Disease Control and Prevention (CDC) now categorizes skin cancer as epidemic. Nearly 90% of these deadly cancers start from sun exposure during the childhood years. This makes sun exposure in school-age children a serious public health risk, also one that school nurses can address. Solar radiation is now classified as a "known human carcinogen," with ultraviolet rays joining the ranks of other known cancer-causing elements such as tobacco, arsenic, and radon. Sun exposure to unprotected skin results in painful burns, premature aging, cataracts, and weakened immune systems. School nurses can use the new CDC guidelines along with other local and state resources to develop a specific skin cancer prevention program for their schools. They are in a pivotal position to partner with students, parents, administrators, teachers, and coaches to reduce the occurrence of skin cancer in children. The article describes one high school's skin cancer prevention project.     

手术室护士 HIV 职业暴露的危险因素及防护措施的研究进展

本文综述近年来国内外对手术室护士发生人类免疫缺陷病毒（HIV）职业暴露的危险因素及防护措施,其主要影响因素包括手术室护士岗位的特点、护士心理和身体特征、操作流程、防护用品的使用、暴露后处理流程不规范。主要措施包括对护士培训、心理和生理因素的预防、规范操作流程、防护措施、暴露后正确处理流程。对护士实施知识培训、提高防护意识、规范操作流程等措施可有效预防并降低手术室护士发生 HIV 职业暴露的风险。     

Enfermería en salud medioambiental. Experiencia en una unidad de salud medioambiental pediátrica

Nursing occupies a strategic and privileged position to address many of the issues concerning children's environmental health. Nurses are the health professionals that work most closely with patients and their families and are in an excellent position to identify children at risk and advise their parents about the best practice to reduce or prevent environmental threats. Pediatric environmental health specialty units (PEHSU) can help to train and support nurses in this task. The activities of nurses in the PEHSU can be classified into five groups: nursing care, teaching, research, environmental management and school environmental health. Nursing associations and institutions should ensure that pediatric environmental health is compulsory in the undergraduate and postgraduate training of current and future nurses.     

Children's nurses' post-operative pain management practices: an observational study

BACKGROUND: Children continue to experience unrelieved moderate to severe pain post-operatively despite the evidence to guide practice being readily available. Previous studies have relied on self-report measures; there is a need to establish exactly how nurses manage children's pain in practice. OBJECTIVES: To ascertain how nurses actually manage post-operative pain in children and whether pain management practices adhere to current best practice guidelines. DESIGN: An observational study was carried out. Structured and unstructured data were collected. SETTING: A children's surgical ward in the English Midlands caring for children from birth to 16 years. PARTICIPANTS: Registered nurses (n=13) took part in the study. METHODS: Each participant was observed continuously for a period of 5 hours per shift for two to four shifts each. The role of the observer as participant was adopted whereby the researcher could shadow the nurse and act primarily as an observer. Data were collected for 36 shifts (185 hours). RESULTS: While nurses administered analgesic drugs when a child complained of pain, in most other areas practices did not conform to current recommendations and are in need of improvement. Nurses did not, for example, routinely assess a child's pain, nor use non-drug methods of pain relief on a regular basis. CONCLUSIONS: The sub-optimal pain management practices may be attributable to several factors. The professional culture of nursing and/or ward culture may result in poor pain management practices being perpetuated. Nurses may not have the requisite theoretical knowledge to manage pain effectively. A lack of priority may also be attributed to pain management. These areas need exploring further.     

School nurses' perceived barriers to diabetes knowledge, communication and management in children with type 1 diabetes

Diabetes is a common chronic illness among children, with 13,000 new cases diagnosed each year. School nurses are in a unique position to facilitate the improvement of health for students with diabetes, but they face many challenges in acquiring diabetes knowledge, communicating with parents and healthcare providers, and managing children and adolescents with diabetes. To learn more about these challenges and the potential role of technology in alleviating them, we administered a survey to school nurses in the state of Maryland. Results indicated that lack of access to knowledge and time constraints were the biggest challenges in providing support and care to children with diabetes. The majority of the school nurses agreed that use of an electronic medium will significantly enhance care and improve knowledge and communication between parents, school nurses and providers.