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           At this year’s New Albany Kindergarten Round-up, nursing students performed screenings for incoming kindergarteners. We performed hearing screens, as well as vision and color-blindness tests. Many parents brought their children to the Jeanne B. McCoy Community Center for the Arts on May 22^nd to have these preventative tests completed. These screens are essential in identifying potential problems in vision or hearing. The vision test performed was a simple visual acuity tests, looking to see if a young child can identify shapes from five feet away. The hearing test was a pure tone audiometry screening, using a series of sounds at different frequencies.

            During my time at the Kindergarten Round-up, I was at the hearing station. Many children of all different backgrounds came in to receive these screenings as preventative care. Without these screenings, timely intervention may not be attainable resulting in further issues for these growing children. If these soon-to-be kindergarteners did not receive these screenings and issues were to arise, this could significantly impact their development as well as their education. They may struggle to focus in class due to not being able to hear their teacher or classmates or fail to read letters of the alphabet on the wall because they were unable to see from a shorter distance.

            At the hearing station, I was able to play different tones at varying frequencies in each ear to help identify a potential complication. If a child was unable to hear a tone, they would “fail” that ear, but would be re-screening at the beginning of the school year. Some challenges I faced with these children was the inability to focus on the task due to being distracted, as well as difficulty in following directions. We tried our best to make the room as quiet as possible to give the children the highest chance of hearing the tones, but with other children and their parents in the room, it was not always attainable. Some children were very shy and did not want to speak with the nursing students or they became too upset to get close to us. Even with these few students who struggled with this environment, most children had very successful screenings.

            The United Nations Sustainable Development goal that relates most with these preventative screenings is goal #3, which is good health and well-being. These tests performed at an early age works to recognize signs of difficulties allowing for early intervention and resources. Without these test, children and their families may have further struggles, preventing these kids from achieving good overall health and wellness.

Resources

United Nations. (n.d.). The 17 goals | sustainable development. United Nations. https://sdgs.un.org/goals

Wang, C., Bovaird, S., Ford-Jones, E. L., Bender, R., Parsonage, C., Yau, M., & Ferguson, B. (2011, May). Vision and hearing screening in school settings: Reducing barriers to children’s achievement. Paediatrics & child health. https://pmc.ncbi.nlm.nih.gov/articles/PMC3114988/

Figure 1: Ohio Reformatory for Women (Ohio Department of Rehabilitation and Correction, n.d.)

Today, our Community Health rotation took us to the Ohio Reformatory for Women in Marysville, Ohio. Walking in, I had a preconceived notion of what life was like for incarcerated people and correctional nurses. My notions were proved wrong almost immediately after entering the reformatory premises. Correctional nursing is aimed at providing healthcare to people in prison, who often experience healthcare disparities.

During today’s clinical, my classmates and I toured the Ohio Reformatory for Women’s grounds, including the infirmary and the Residential Treatment Unit. We were fortunate to sit for a panel of women, who described their experiences in prison. They shared positive and negative stories about the healthcare received in prison. One talked about how the correctional nurses can be extremely helpful in receiving proper care, but they can also be a huge barrier. She told us nursing students to “be perceptive.” She explained that great nurses and healthcare workers have the ability to notice things that are not easily recognizable to others. That can be crucial to providing great healthcare. A cultural difference for correctional healthcare is the stigma and bias. In hospitals, inmates often face bias due to their criminal background. However, from my experience today, I noticed that many of the correctional nurses and administrators are huge advocates for the women at the reformatory. My future job is not to judge, it’s to take care of the human being in front of me.

One health concern from the reformatory is the mental health of the women at the reformatory. One of the panelists told us that more than 90% of the women incarcerated at the reformatory have experienced some form of abuse in their lifetimes. In July 2023, the reformatory opened a mental health treatment center, one of the first of its kind in the nation. This center aims to increase the mental (and overall) well-being of all the women at the reformatory. Today’s experience can be associated with the goal 10 of reducing inequalities. Correctional nursing helps bridge the gap between prison populations and healthcare access. Also, the mental health treatment center helps this population have access to care for their mental and emotional well-being. Incarcerated individuals are often underserved in this realm, but these resources are trying to reduce that inequality.

My big takeaway from this experience was how Ohio is a leading state in rehabilitation in prisoners. Also, the state is funding mental health resources in prisons to aid in the mental well-being of incarcerated people. While touring the premises, I noticed many women utilizing these services to better their mental well-beings and overall well-beings.

I have been helping at the STEPP Clinic (Substance abuse Treatment, Education and Prevention Program). Pregnant women with addictions can receive high-risk obstetric care along with treatments on an inpatient and/or outpatient basis. This was such an eye-opening clinical experience for me. It was so personal for the patients, and everyone was so welcoming on the care team. This clinic provides crucial resources for expecting moms and has graduated 52 moms to date (yay!!) One specific assistance that this clinic connects patients with is Physicians CareConnection (PCC). PCC then connects pregnant patients to a plethora of other resources like housing & utilities, access to nutritional foods and prenatal supplements, prenatal care, transportation assistance, etc. OSU’s STEPP Clinic and PCC service both work to meet the Sustainable Development Goals of good health/well-being and reduced inequalities by enabling struggling pregnant women to seek and receive medical care they may not have otherwise had access to. Unfortunately, I was not allowed to take pictures at the clinic (to protect the women there who may have been victims of trafficking, abuse, etc.), but I did include a graphic about PCC and their services.

Today, I began my Community Health journey at Hilliard Tharp Sixth Grade. This elementary and middle school serves the fourth, fifth, and sixth grades. When I walked in through the doors before the first bell rang, I was immediately greeted by the school nurse, Katie Frenz. She excitedly introduced me to all the faculty and staff of the building, calming my nerves. Then, Katie walked me through the day’s schedule and the responsibilities w

e’d plan to tackle. But, just like any other nursing job, things did not get exactly as planned. There were unexpected student visits, shifting priorities, and the kind of organized chaos that only the school nurse can handle. Flexibility and adaptability were the true champions of today!

The school nurse has to deal with many health concerns for students including asthma and diabetes management, first aid from injuries at recess, and mental wellness. The day started off with Katie planning a day where a mobile dental clinic would come to the school and provide services to some students. She had to plan the schedule, location, and transport for many students to get these services. Next, Katie and I conducted a standard vision and hearing test for a student to put on file with the State of Ohio. After that was completed, we started planning for a class to teach fifth grade students about the growth and development changes. The topics covered included puberty, hygiene, peer pressure, body image, and much more. In between all these responsibilities, the school’s clinic assessed for many abrasions, tummy aches, and muscle aches. Many phone calls to parents were interspersed throughout the day about the health and wellness of their children. At times, communication could have been difficult because language barriers made if hard for some parents to understand what was going on. However, many of the students were bilingual and able to translate between Katie and the parents.

This day at the middle school relates toGoal 3 (Good Health and Well Being) of the United Nations. The role of the middle school nurse is to ensure that no student’s current or potential health problems go unnoticed. The school nurse is the liaison between faculty, staff, students, parents, and physicians. They conduct health screenings for vision and hearing, allowing easier access to these resources. In my opinion, the biggest role of the school nurse is education – especially in middle school. This is the age group where students start to feel awkward and self-conscious about their changing bodies. Katie reinforced that she is a resource for education on preparing and coping for these changes. My biggest takeaway from my experience today is that school nurses must be just as flexible and adaptable to their diverse environment as a nurse does in the hospital. Many surprises came into the school clinic today, but Katie handled every toss and turn with grace and the utmost respect for her patients and their parents.

            At Linden-Mckinley STEM Academy, 7^th-12^th graders eagerly await their upcoming summer break. While this long break from school is much needed for all students and teachers alike, it can cause further nonadherence issues in students with diabetes. Teenagers and young adults at this high school, and many in the United States, are struggling with compliance to their diabetes management plans.

            Currently, at Linden-Mckinley, there are two students registered with the nurse’s office with a diagnosis of Type 1 Diabetes Mellitus. There are also another two students with Type 2 Diabetes Mellitus. One of the school nurses, Sasha Ackerman, explains that there are multiple other students in the school that are diagnosed with Type 2 Diabetes, but remain unregistered with the nurse’s office due to non-insulin-controlled therapies including metformin.

            Students with diabetes are supposed to come to the school nurse in the morning and check their blood sugar, eat breakfast, and cover their meals with insulin if need be. On multiple occasions, students will have sugars over 800 mg/dL in the morning. Their measurements fluctuate so often they might have a hypoglycemic event later in the day after gym class. Students at Linden-Mckinley, especially towards the end of the school year, are often suspended or skip class. Consequently, students who require treatment for their diabetes may not even be present for illness management. Adherence is further complicated by disincentives of painful needlesticks, the nuisance of carrying or wearing insulin administration devices, premature shift in responsibility for management from parents to teens, fatigue from chronic illness, and physiologic changes leading to greater insulin resistance during puberty.

            Positively, there are many successful school-based implementations at Linden-Mckinley, such as the Diabetes and School Health (DASH) Program through Nationwide Children’s Hospital. This program works with the school nurses to provide additional access and care for Type 1 diabetics. This program works through direct on-site clinical care, education, further support, and more accountability for patients. However, this program only works with Type 1 diabetics, but there have been conversations of a program that reaches those with Type 2 diabetes as well.

            Students in this school district, and many around the United States, come to school to escape their struggles from their home lives. Adding an intense diabetes regimen only increases their stressors leading to more challenges in reaching successful illness management. Further resources are needed at this school, including a glucose monitor, such as an Accu-Check, available for all students, in addition to more nutritious school lunch options and after school exercise programs. The United Nations sustainable development goal that corresponds best with this issue is good health and well-being. To summarize, these students deserve more support and more resources to find success in their journey to overall wellness. The school nurses do an outstanding job of supporting their students throughout their day, but sometimes it’s what happens after school is over that is pivotal.

Resources

Azar, S., Maroun Abou Jaoude, N., Kędzia, A., & Niechciał, E. (2024, September 24). Barriers to type 1 diabetes adherence in adolescents. MDPI. https://www.mdpi.com/2077-0383/13/19/5669

L;, B. J. (n.d.). Adherence challenges in the management of type 1 diabetes in adolescents: Prevention and intervention. Current opinion in pediatrics. https://pubmed.ncbi.nlm.nih.gov/20489639/

United Nations. (n.d.). The 17 goals | sustainable development. United Nations. https://sdgs.un.org/goals

Yen, F.-S., Wei, J. C. C., Liu, J.-S., Hwu, C.-M., & Hsu, C.-C. (2023, November 1). Parental income level and risk of developing type 2 diabetes in Youth. JAMA network open. https://pmc.ncbi.nlm.nih.gov/articles/PMC10690454/

Sideway Story from Westgate Elementary

My experience at New Albany Public school was so insightful. I got to see first hand how school nursing helps influence the healthy development of children. I got to attend the primary school (grades K-3) and the Early Learning Center (Pre-K and Kindergarten). There were a lot more children that came through and interacted with the nurse than I thought there would be. Many kids came into the primary school clinic to receive medication for ADHD and insulin for diabetes. I was surprised at how self-sufficient and independent they were. At the ELC we had less children coming in to receive medication and a lot more injuries and illnesses. One kid even shoved a piece of crayon in his ear and I got to help extract it! Another child had an ear infection and I got to view an inflamed eardrum. I did not see many “cultural differences” but I was shocked to see that New Albany has a lot of children with special needs that are completely integrated with their able-bodied peers. I got to see a child with down syndrome with a peg tube “eating” with the other children and interacting with them. 

Goal 3 in the sustainable development goals closely aligned with what I observed in New Albany. The goal, “ensures healthy lives and promotes well-being for all and at all ages” The types of posters in the pictures attached are present all over the schools and are there for children to learn about and incorporate cleanliness and emotional regulation. These posters provide reminders for children who still need to practice these skills and allow for them to use the pictures as tools. 

One takeaway from my experience shadowing the school nurses is that they create important relationships with the students they serve. Initially I thought that school nurses were only there to fix “boo-boos” and apply ice packs. I ended up learning that they educate, ensure vision and hearing compliance, and are important community members that children rely on to keep them safe and at school. 

Department of Economic and Social affairs. (n.d.). Transforming our world: The 2030 agenda for sustainable development. United Nations. https://sdgs.un.org/2030agenda

During my community health clinical at New Albany Primary School, I observed an example of a positive reinforcement initiative where students earn tokens for getting “caught” displaying good behavior. These tokens can be redeemed at a book vending machine creating an engaging and creative way to promote literacy and positive behavior. The primary population served at the primary school is roughly ages 5-10 serving primary grades K-3.

Students earn coins for doing good deeds that they can use to redeem brand new books that they can take home with them!

The sustainable growth goal that I would like to focus on would be good health and well-being which directly connects to this clinical experience. This also connects to goal #4 of ensuring inclusive and equitable quality education and promote lifelong learning opportunities for all.  The school’s initiative to reward positive behavior and support literacy ties into promoting mental well-being, emotional growth, and creating a supportive environment that nurtures students’ development both academically and socially. My biggest “aha moment” was seeing a non-traditional strategy, like a book vending machine, and the huge impact it can make on a student behavior and motivation.

May 9, 2024 by Ashley Wells

Today I spent the day at Hilliard Innovation Learning Center with the lead school nurse, Robin. Hilliard ILC is a part of Hilliard city school district and provides specialized care to students with special interests and needs. The ILC provides students with course work following specific career paths that they may be interested in after graduation such as healthcare, business and film. They also provide students who struggle with following the standard curriculum a student success network to help them have the resources to graduate. Next door to the ILC is also the LEAD program which assists with children who may have behavioral issues related to trauma. On this campus kids can anywhere from elementary to high school.

While I was at the ILC, Robin educated me on the care team she oversees to assist with these programs. It consists of fourteen employees, multiple nurses, athletic trainers and social workers.  Throughout the day we assisted kids with medications at lunch and worked on training manuals for incoming nurses. I found it really interesting the training that goes into being a school nurse but also the extra requirements for one in this kind of setting.

I found the ILC to be really interesting in the way that they have developed a way to assist children with all different education goals. As someone who grew up in the Columbus area I wasn’t aware that any of the public schools besides Olentangy local schools offered alternative learning. I feel that this addresses sustainable goal number four, ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, specifically with the student success network (Department of Economic and Social affairs, n.d.). My overall take-away from this experience is that I am really liked the setting and would be really interested in working as a school nurse or NP in a school like Hilliard ILC.

References

Department of Economic and Social affairs. (n.d.). Transforming our world: The 2030 agenda for sustainable development. United Nations. https://sdgs.un.org/2030agenda

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