Show Me the Outcomes in School Health

Katie is a 16-year-old female who presents to the School Nurse’s office frequently—often at the verge of tears. Her respiratory rate is rapid, she has poor eye contact, and she is visibly upset. As the School Nurse, you have known Katie for five years and recall her history of generalized anxiety. Knowing this information, what outcome do you want to help Katie achieve? Most likely your outcome is to help Katie improve her coping skills and manage her anxiety, but what interventions can you do with Katie that will help her achieve this outcome? Although much of school nursing appears to focus on interventions (what we do to help students like Katie), it is essential for School Nurses to identify the desired outcome first, then implement interventions to achieve that outcome, and finally measure that outcome in situations such as Katie’s to see if the intervention was successful. Outcomes are viewed as measures of effectiveness in health care and education. It is challenging for School Nurses to monitor health outcomes of students, families, and communities within the educational setting, where the focus is on educational outcomes. Anecdotally, School Nurses can describe countless positive outcomes from their interactions with students, faculty, and families. Unfortunately, the ability to demonstrate measurement of school nursing outcomes in a consistent manner is not so easy. Several research studies recently identified the link between interventions and outcomes in the school setting. These articles provide an excellent starting point for discussion and further development of outcome measurements by School Nurses (Maughan, 2003; Selekman & Guilday, 2003; Weismuller, Grasska, Alexander, White, & Kramer, 2007). With No Child Left Behind (U.S. Department of Education, 2002), outcomes in education have become well recognized by the public and the education system. Educational outcomes can be simply defined as “academic success” and have been most recently defined through No Child Left Behind classifications as proficient or nonproficient (U.S. Department of Education, 2002). Standardized tests provide the outcome measurements that allow the educational system to track a student’s progress or need for further assistance. The use of teaching methods, education’s interventions, for groups of students at similar educational and developmental levels enables students to learn and apply information taught in the classroom that is then documented by these standardized tests. School nursing outcomes and their measurement are in initial stages of development and use and are more difficult to define. The role of a School Nurse is often described with a taskoriented framework (Selekman & Guilday, 2003). Consequently, many School Nurses are evaluated on the basis of the frequency of the tasks performed instead of the student’s or population’s response to interventions. School nursing practice is based on the nursing process, which was previously known as a fivestep process that included assessment, diagnosis, planning, interventions, and evaluation. Ultimately, to evaluate the effectiveness of a plan of care and the interventions, a nurse needs to identify the anticipated outcomes prior to initiating the plan of care. School Nursing: Scope and Standards of Practice (American Nurses Association & NASN, 2005) incorporates a sixth step in the nursing process, so the nursing process is now recognized as assessment, diagnosis, outcome, planning, interventions, and evaluation. The inclusion of an anticipated outcome and how this outcome will be measured before any interventions are initiated is essential to measure the effectiveness of nursing care. Intuitively, School Nurses may think about outcomes they are trying to achieve, but unless there is a consistent documented measurement of outcomes, it is difficult to determine the most effective interventions to reach an outcome. The Nursing Outcomes Classification (NOC) system (Moorhead, Johnson, Maas, & Swanson, 2008) is a method to incorporate outcomes and outcome measurement into school nursing documentation. Each NOC outcome has a definition with a list of possible indicators used to measure the outcome. When developing a plan of care, the NOC outcome is linked to a nursing diagnosis (NANDA) and the interventions (NIC, or nursing interventions classification) used to reach the outcome. The NOC system is recognized by the American Nurses Association (2006), and the most recent edition of NOC (Moorhead et al., 2008) includes 385 outcomes that incorporate seven different domain areas, including functional health, physical and psychological health, health knowledge, perceived health, family health, and community health. The NOC system uses 5-point Likert-type scales to measure progress toward an expected