PART A

After becoming a school nurse, I understood that addressing students’ health necessities is fundamental in the realization of optimal learning. I am an advocate of a concerted school health structure designed to safeguard the essential community health and educational significance learners present. Similar to any other registered nurses, the school nurse’s function includes direct care, teaching, and assigning health care duties to others per established rules and procedures. In this article, I will reflect on quality and safety, evidence-based practice, leadership, and community and population health and how my placement as a school nurse has impacted on these areas with specific incidents for elaboration.

Applied Leadership

Before becoming a school nurse, I believed that as a school nurse responsibilities were minimal. However, this mindset was changed when I learnt the role school nurses play in advancing the wellbeing, academic accomplishment and health of learners. In this practice, ensuring learners are healthy, safe in school and equipped to learn takes primacy. The realization of these objectives requires competence in leadership. As a school nurse, I have spearheaded the formulation of policies, plans, and measures essential in the delivery of school health amenities at a personal level banked on student-centered, evidence-based practice to inform care. Assimilating morals tipulations into all aspects of practice has enabled me to lead in the delivery of care that upholds and safeguards student and family independence, poise, confidentiality and other privileges receptive to diversity in the college environment.

When I joined my current school, the school did not have the necessary equipment to support students with special medical needs. I remember a teen presented symptoms of a severe asthma attack, and we had to send her to the nearest hospital as the school could not facilitate intubation. After the incident, I petitioned the administration to acquire oxygen tanks, suction equipment, urinary catheterization kits and emergency provisions for students with special needs. The institution improved its facilities and is admitting students with different disorders, and it has become common to see students with walkers and wheelchairs on campus.

As every student’s advocate, a school nurse encourages self-empowerment, problem solving, active communication and cooperation with others through care and education. Endorsing the idea of self-management is a crucial feature of my position and allows students to deal with their disorders and exercise autonomy. When dealing with diabetes students, I introduced them to the concept of self-care. I encouraged them to eat healthily, be physically active, comply with medical directives and adopt risk reduction behaviors. The students took my ideas, and their visits to the clinic reduced, and some are in various school teams. I advocate for wellbeing by spearheading the formulation of policies and guidelines to tackle harassment, institutional fighting, and other forms of emergency incidents that may transpire at school.

From personal knowledge, at the policy formulation and execution point, school nurses offer organization-level leadership and serve as proxies of change, indorsing healthcare and education restructuring. I believe it is the responsibility of a nurse to assist in enhancing issues allied to healthcare, consumer care and wellness.

Evidence-based practice

The practice of EBP details the incorporation of personal medical proficiency with the best accessible peripheral clinical to corroborate from structured exploration. Empirical evidence indicates that it is challenging to transfer research into practice as it takes over a decade before research findings become fully assimilated into regular practice(Adams & McCarthy, 2005). inaccessibility of research, poor grasp of the research method, and unsatisfactory expertise in appraising studies, time limitation and little backing for organizational structure for change are common hindrances to EBP application. From personal knowledge, the barrier to adoption of EBP in school nursing is insufficient time and lack of support because I work in isolation and do not enjoy the luxury of consulting a colleague in a hallway.

The advances and changes in the healthcare system, I use online resources to review and update my practice frequently. Accessing updated nursing procedures has contributed to enhancing my nursing and safeguarding the health of students using best practices. For instance, there was a student who suffered from catheter urinary tract infection that had affected her class attendance as she was often visiting the hospital. Urinary tract infections are common contagions associated with the introduction of a urinary catheter. After examining her case, I decided to conduct a daily review for the need for a urinary catheter, ensured the catheter was connected to the drainage system and performed mundane daily hygiene, including perineal care. The objective was to ensure I remove the catheter once it became unnecessary. An article informed the practice on minimizing CAUTI incidents by limiting urinary catheterization to patients who have clear indications for it and quick removal of the catheter when it became useless.

Numerous medical emergencies characterize learning institutions. From experience, injuries account for almost two-thirds of primary complaints while emergencies such as breathing difficulties and seizures account for a third. When I became a school nurse, vagal nerve stimulation was being introduced as a treatment for epilepsy. A year after of practice at the institution, there was a student who presented manifestations of partial epilepsy and had crashed numerous medications and was not suitable for epilepsy operation. I advised the parents to try vagal nerve stimulation as it was an adjunctive therapy for partial-onset seizures in epilepsy patients (Singh, Sankaraneni& Antony, 2017). When the student underwent the procedure, the seizures declined significantly, indicating the gradual effectiveness of VNS in patients over years of exposure.

Community and population health

Serving as a school nurse has enabled me to contribute towards enhancing health outcomes in the community by offering essential education to my students. I train students on areas, for example, healthy lifestyle, risk-decreasing behaviors, age-related needs, and precautionary self-care using approaches suitable to students ‘cognitive level, keenness and ability to learn(Subahi, 2019). Students rely on me for sex education and related health issues, especially on STDs and unwanted pregnancies. For instance, there was an outbreak of syphilis in the institution and the school became frenzy as students accused each other of spreading the disease as others believed they were going to dies. I mitigated the situation by providing the necessary treatment and offering relevant education on prevention against STDs. Since a majority of students are sexually active, abstinence was ineffective, and as such, I recommended the use of condoms and sticking to one partner. Evaluation of the incident prompted me to advocate for the inclusion of sex education in the school’s curriculum as most students were ignorant and had been misled on the subject.

I realize that as a school nurse, I provide a secure and healthy learning environment through control of communicable diseases by endorsing vaccines, exhausting school-wide disease control processes, and infection shadowing. For instance, when a student who was ill and presented signs of dysentery, I instructed the teachers to send the student home and only permitted back when the risk of infecting others had elapsed. Although the decision was necessary, I felt terrible because the student was missing class due to a preventable illness. After the incident, I introduced a hand washing campaign and using dryers and paper towels to dry hands(Berhe et al., 2019). The prevention strategies are designed to ensure no child misses school due to infectious diseases and to uphold the overall wellbeing of the population as the students carried the hand washing idea home.

At times, interaction with a school nurse is a student’s first contact with healthcare amenities at the onset of health problems. For example, a student came to the clinic at lunch hour complaining of cramp-like pain and stated she was often bedridden due to period pain. After the assessment, I recommended a pelvic examination which revealed that she had endometriosis(Meena, 2017). After the test, her gynecologist performed laparoscopic surgery to alleviate the situation. I felt proud after the case as I managed to assist a student who was becoming dependent on painkillers, and her education was suffering due to absenteeism. The incident motivated me to start an awareness campaign on endometriosis and encouraged students to visit gynecologists regularly for early detection and treatment. I learnt that I could contribute to the community or public health through education and awareness regarding various medical cases.

Quality and safety

While school nursing is a distinct specialty, it still subscribes to core competencies of safe and quality nursing care. Reliable and quality care pertains to the nurse’s aptitude in a demonstration of expertise based on the patient’s health or illness status and deliver informed decisions (Lazarte, 2016). From experience, diarrhea, headaches, stomach aches, colds and flu, allergies and conjunctivitis are common illnesses among students. A student came in with inflamed, itchy nose and throat, eye irritation and runny nose. After the assessment, I realize that these were manifestations of airborne allergens which prompted me to give antihistamine pills and corticosteroids for treatment(Sánchez & Castro, 2019). The incident left me feeling competent as it happened on my first day of reporting. After the event, I created posters and circulated to enable students to learn how to manage and avoid allergy reactions.

At times I feel like I am working in the ED because I see students with schoolyard injuries requiring sutures, a tracheostomy tube detached by a curious student, status epilepticus or a ‘stomach-ache’a manifestation of appendicitis. Last week, a student in status epilepticus was rushed in the clinic, I administered benzodiazepines intravenously to facilitate quick access to the brain without the danger of severe systematic and neurologic adverse effects(Ochoa &Kilgo, 2016). After the student had stabilized, he was taken to the ED for further examination. The incident left me feeling as excited and relieved after the student had stabilized. I realized that my training had prepared me to promote safety and comfort for patients, set priorities for care and ensure continuity of care. Also, after reflection on the incident, I learnt that for a nurse to provide safe and quality care, they should remain calm and make sound decisions as any mistake could culminate in adverse outcomes for a patient.

In healthcare, quality and safety enhancement is an incessant and logical process that results in quantifiable developments and results. In nursing, quality and safety improvement involves evaluation, isolation of the concern, formulation of a course of action, execution of the procedure and appraisal of the consequence. When I joined my current institution, I realized most of the sports-related injuries were concussions from playing rugby among students. The shocks threaten the wellbeing and long-term health of students. In this case, I recommended that the institution acquire protective headgear for students participating in the sport. After the introduction of the helmet, the injuries and incidents have declined significantly(Sone et al., 2017). In this case, I was able to perform a comprehensive review, formulate an action program in alliance with the administration and addressed the issue of concussion injuries. Evaluation of the case shows that school nurses can contribute towards the reduction of sport-related injuries and enhance safety.

PART B

B1: Nurse Theorists

Based on my practice and reflection on my practice, it is evident that different theorists inform my beliefs on quality and safety, evidence-based practice, leadership, and community and population health areas of nursing. First, my approach in community health is grounded in Florence Nightingale’s Environmental theory as I believe environmental factors such as poor sanitation impact on the health and wellbeing of a patient(Medeiros et al., 2015). As such, it is essential to empower people through education and awareness of combating various environmental factors in combating illnesses. In this sense, I chose to educate students on washing hands, engaging in protected sex, and how to manage their medical conditions.

Secondly, my approach in quality and safety is underpinned by Fay Abdellah’s Topology of 21 Nursing Problems theory that focuses on the needs of the patient and the contributions of nurses in problem identification exhausting a problem breakdown method. The method was reformist in the era because it discussed to nursing analysis in a period in which nurses’ training neglected diagnoses as they were not part of a nurse’s duties in healthcare(Petiprin, 2016). The theory is essential in providing safe and quality care for because it encourages nurses to exhibit knowledge-based on patient status, ensure encyclopedic decision-making, and promote the safety and wellbeing of patients. I have utilized the model in numerous instances, especially when I am forced to conduct comprehensive and systematic assessments before formulating a care plan in partnership with the patient and other practitioners.

Pundits define the evidence-based practice as a means of assimilating personal clinical knowledge with the best obtainable secondary clinical proof from a systematic study. Relating this definition to Patricia Benner’s From Novice to Expert theory reveals some degree of similarity, and as such, I base my evidence-based practice and thoughts on her thoughts(Petiprin, 2016). She holds that expert nurses develop knowledge and comprehension of patient care over time through education and practice experience. When I became an RN, I was incompetent, but I have grown in confidence and am gradually becoming an expert.

In nursing, leadership is defined as influencing others to improve the quality of care, along with participation in clinical care. Madeleine Leininger shared similar sentiments in the formulation of her Culture Care Diversity and Universality theory that focuses on improving quality of care. Early in her career, Leininger observed absence of cultural and care awareness during delivery of care which is an essential element in supporting compliance, healing and wellness in patients (Leininger, 2002). Through her theory, Leininger has managed to influence the nursing practice to incorporate cultural competence in practice as a strategy to improve quality of care through enhanced nurse-patient relationship. Leininger’s model became a movement that encouraged the provision of social care based on values, beliefs and practices of a patient. Personally, this is an explicit elaboration of leadership in nursing.

B2:Strategies of Self-Awareness and Self-Care

Quality and safety

Self-awareness is a crucial aspect of the nursing profession. With insight, nurses enhance their aptitude in the delivery of excellent nursing care and finally, contentment inpatient care. I will utilize objective self-reflection to evaluation my decision-making process and how my decisions impact those around me to strengthen my self-awareness. Also, I will use journaling to record my thoughts and decisions regarding safety and quality of care I offer students. I will augment my reflections and journaling with my self-care program. The plan includes professional care that involves engaging in regular supervision and consulting experienced nurses regarding safety and quality of care. Maintaining physical fitness will be integral in ensuring am healthy and alert, which is essential in decision-making.

Evidence-based practice

Evidence-based practice requires nurses to be updated on current healthcare literature. As such, it is essential to consult friends and supervisor after performing a particular task, especially after using a new procedure on a patient. Gaining feedback from stakeholders will provide an understanding of the efficiency of EBP. I will also utilize journals to record my practices for assessment and improvement in future. Integration of EBP in nursing requires confidence and emotional wellbeing, thereby creating the necessity for psychological and spiritual self-care. These self-care practices such as yoga and reflective meditation will allow me to have a perspective beyond daily life, thus allowing me to resume duty well am rejuvenated and inspired.

Leadership

Self-awareness is essential in leadership as it creates the base for a strong character, ability to lead with purpose, trust and authenticity. Maintenance of excellent leadership necessitates journaling, reflection, consultation and seeking feedback from colleagues and patients. Employment of these self-awareness strategies assists in the identification of gaps in my management skills and reveals my strengths and areas that need improvement. I will also integrate self-care methods such as physical and emotional self-care to enhance my leadership. Emotional self-care includes developing supportive relationships, participating in physical activities, engaging friends, and attending social events.

Community and population health

As a school nurse, I belong to two deviating communities, and as such, I must communicate confidently and dynamically cooperate with consultants from different fields. As an administrator, I organize students’ care between the clinic, school and family. Harmonizing care requires emotional intelligence skills and self-awareness, as most incidents related to healthcare are often stressful. First, I will improve my professional wellbeing by engaging in regular consultation with all stakeholders, be strict with boundaries between the communities and attend professional development as a self-care strategy. I will also utilize journaling, reflection, write down my goals, plans and priorities and practice meditation as my self-awareness strategy. These strategies will assist me in recognition of where my beliefs and feelings are leading me and make the needed alterations.

References

Adams, S., & McCarthy, A. (2005). Evidence-Based Practice and School Nursing. The Journal of School Nursing, 21(5), 258-265. https://doi.org/10.1177/10598405050210050301

Berhe, H., Makinde, O., &Theuri, D. (2019). Modelling the dynamics of direct and pathogens-induced dysentery diarrhoea epidemic with controls. Journal of Biological Dynamics, 13(1), 192-217. https://doi.org/10.1080/17513758.2019.1588400

Lazarte, F. (2016). Core Competencies of Beginning Staff Nurses: A Basis for Staff Development Training Program. Journal of Advanced Management Science, 4(2), 98-105. https://doi.org/10.12720/joams.4.2.98-105

Leininger, M. (2002). Culture care theory: A major contribution to advance transcultural nursing knowledge and practices. Journal of transcultural nursing, 13(3), 189-192.

Medeiros, A., Enders, B., & Lira, A. (2015). The Florence Nightingale’s Environmental Theory: A Critical Analysis. Escola Anna Nery, 19(3). https://doi.org/10.5935/1414-8145.20150069

Meena, J. (2017). Story of a Giant Endometrial Polyp in Asymptomatic Postmenopausal Female. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. https://doi.org/10.7860/jcdr/2017/24801.9482

Ochoa, J., &Kilgo, W. (2016). The Role of Benzodiazepines in the Treatment of Epilepsy. Current Treatment Options in Neurology, 18(4). https://doi.org/10.1007/s11940-016-0401-x

Petiprin, A. (2016). 21 Nursing Problems by Faye Abdellah – Nursing Theory. Nursing Theory. Retrieved 9 April 2020, from https://nursing-theory.org/theories-and-models/abdellah-twenty-one-nursing-problems.php.

Petiprin, A. (2016). Leininger’s Culture Care Theory – Nursing Theory. Nursing Theory. Retrieved 9 April 2020, from https://nursing-theory.org/theories-and-models/leininger-culture-care-theory.php.

Sánchez, G., & Castro, C. (2019). Prescription Profile and Clinical Outcomes in Patients with Allergic Rhinitis Treated with Oral Antihistamines or Nasal Corticosteroids. International Archives Of Otorhinolaryngology, 23(03), e325-e330. https://doi.org/10.1055/s-0039-1688968

Singh, S. P., Sankaraneni, R., & Antony, A. R. (2017). Evidence-based guidelines for the management of epilepsy. Neurology India, 65(7), 6-11. DOI: 10.4103/neuroindia.NI_1027_16

Sone, J., Kondziolka, D., Huang, J., &Samadani, U. (2017). Helmet efficacy against concussion and traumatic brain injury: a review. Journal of Neurosurgery, 126(3), 768-781. https://doi.org/10.3171/2016.2.jns151972

Subahi, N. (2019). Effectiveness of Cognitive Conflict Strategy in Improving Academic Achievement and Modifying Sex Education Misconceptions in Science Course among Intermediate Second-Grade Students. World Journal of Education, 9(2), 90-102. https://doi.org/10.5430/wje.v9n2p90