Abstract
Purpose: This paper reports on a course developed for school nurses. The course focused on locating reliable and high-quality medical information resources on the Internet.
Setting/Participants/Resources: The Health Sciences Library System (HSLS) of the University of Pittsburgh formed a partnership with the Pennsylvania Association of School Nurses and Practitioners (PASNAP). Through this partnership, a hands-on course was offered at the PASNAP annual conference.
Brief description: As one component of the Health Information for the Public Project, a subcontract of the National Library of Medicine, HSLS collaborated with PASNAP. This collaboration resulted in HSLS librarians' offering a course titled “Access to Electronic Health Information for School Nurses” at PASNAP's annual conference. This paper describes the school nurse population, their professional information needs, and the development of the course curriculum.
Results/Outcome: This course provided participants with the skills to effectively utilize the Internet to locate high-quality medical information.
Evaluation method: A course evaluation and impact survey were used to assess the effectiveness of the instruction.
INTRODUCTION
It is essential that the school nurse population be able to locate reliable and authoritative health information on the Internet. To meet this need, the Health Sciences Library System (HSLS) of the University of Pittsburgh collaborated with the Pennsylvania Association of School Nurses and Practitioners (PASNAP). This collaboration was part of the Health Information for the Public project, partially funded by the National Library of Medicine with Region 1 of the National Network of Libraries at the New York Academy of Medicine. A review of the literature found no relevant articles on school nurses' receiving training from medical librarian instructors.
BACKGROUND
The Health Sciences Library System consists of four libraries: Falk Library of the Health Sciences, Western Psychiatric Institute and Clinic Library, James Frazer Hillman Health Sciences Library, and Hopwood Library at University of Pittsburgh Medical Center (UPMC) Shadyside: a health resource center for patients and families. Together, they serve the six schools of the Health Sciences at the University of Pittsburgh, as well as the hospitals and facilities of UPMC.
The Pennsylvania Association of School Nurses and Practitioners is a professional association for all certified school nurses and nurse practitioners in the Commonwealth of Pennsylvania [1]. PASNAP joined the National Association of School Nurses (NASN) in 1992, and currently has over 800 active members [2].
School nurses.
The definition of a school nurse is extensive in scope. NASN defines the role of the school nurse as “a specialized practice of professional nursing that advances the well being; academic success and life long achievement of students” [3]. The American Academy of Pediatrics Committee on School Health describes how school nurses provide acute, chronic, episodic, and emergency health care along with education, counseling, and advocacy for students with disabilities [4].
From these descriptions, it is apparent that school nurses have roles ranging from nurse to counselor to advocate in the school districts they serve. An important responsibility of the school nurse in the Commonwealth of Pennsylvania is to provide mandated health-screening tests in grades K through 12. Students are required to have annual height and weight measurements and vision screenings. Grades K, 1,2,3,7,11, and special ungraded classes receive hearing screenings. Grades 6,7, and age-appropriate students in ungraded classes are screened for scoliosis. Tuberculosis testing is conducted when students enter grade 9 [5].
School nurses must also respond to other health issues that may arise during the school day. These health issues may include checking for head lice, monitoring a student with an asthma attack, counseling a pregnant teenager, or dispensing medication to children with a chronic illness, such as diabetes mellitus or a learning disorder. In addition, school nurses often teach, advise, and provide health information to the school district community in which they serve. Through teaching, school nurses can have an influence on the promotion of healthy behaviors in school-aged children [6]. According to members of PASNAP, with all of these responsibilities, it is often difficult for the school nurse to find time to locate the reliable and authoritative health information they need to treat students, families, and the school district community. These needs were taken into consideration when developing the content for the continuing education class.
School nurses are often challenged by the large number of students in their assigned caseload. The school nurse to student ratio varies among communities. Healthy People 2010 and NASN recommend 1 school nurse per 750 students. Currently, statistics show that the ratio in the Commonwealth of Pennsylvania is double that, with 1 school nurse per 1,500 students [7–8]. As a result; Pennsylvania school nurses often travel to several buildings in distant locations. Thus, nurses need consistent access to quality health resources throughout the school district.
METHODOLOGY
After discussions with the president of PASNAP, HSLS librarian instructors developed a continuing education class for school nurses. The class would be taught at their annual conference and would focus on the conference's theme, “ABC's of Caring for Children.” The participants would be charged a modest fee of $30.00 for use of the computer lab at the conference center. During the initial development of the class, several challenges faced by school nurses were identified. These included
computer skills ranging from novice to advanced user.
inability to evaluate Websites with specific criteria.
time constraints.
difficulty in accessing a computer during the school day.
Keeping these challenges in mind, a three-and-a-half-hour, hands-on continuing education class was designed. Sixteen participants registered for the class. The following class description appeared in the conference program: “Access to Electronic Health Information for School Nurses—Learn how to access electronic information to enhance your practice. Have a question, need help with an action plan, need to know about a syndrome? Find out how to access this information during this hands-on workshop with specific sites for school nurses.”
Continuing education class.
The continuing education class focused on three main sections:
Resources from the National Library of Medicine
HSLS's Health Information for the Consumer Website‡
A specialized list of resources geared towards school nurses, accessible from the Heath Information for the Consumer Website
The first section of the class concentrated on how to use MEDLINEplus§. This section was then divided into three categories: research tools, treatment resources, and usability. The research tools category addressed medical encyclopedias and dictionaries, the health topics index, and PubMed canned searches. The treatment resources category focused on clinical trials, and prescription and over-the-counter drugs. Finally, the usability of the MEDLINEplus Website was discussed. It was explained that this Website includes some full-text resources as well as resources in other languages, such as Spanish, and that advertisements are not permitted.
The second section of the class focused on the Health Information for the Consumer Website created by HSLS librarians. The site is structured to promote learning of health and disease topics by starting with dictionaries and texts, then continuing through more advanced topics, such as evidenced-based medicine and decision-making tools. A written description under each topic helps to explain the research tools and print resources. Librarians explained how to use research tools to locate databases and pamphlets under the disease and conditions section. Drug information, medical tests and procedures, and physician directories were also covered. The school nurses were given time to explore these sites briefly, ask questions, and receive one-on-one instruction, if necessary.
During the final section of the class, the specialized list of resources created for school nurses was reviewed. The list was divided into health, government, and organization information resources. On the health information page, Websites such as Bandaids and Blackboards** and a peanut-allergy Website†† were examined. The government information page included the following Websites‡‡: Centers for Disease Control and Prevention, Office of National Drug Control Policy, and “Early Warning Timely Response: A Guide to Safe Schools” produced by the U. S. Department of Education. Finally, information resources from organizations were covered. The participants were introduced to the National Pediculosis Association§§ and the National Center for Tobacco-Free Kids***, among others.
Independent learning exercises.
At the conclusion of the class, the participants received independent learning exercises (Appendix A). The exercises consisted of six questions that could be answered using MEDLINEplus and seven questions that could be answered using the Health Information for the Consumer Website. The questions ranged from “Locate some information on the drug ampicillin” to “Locate the recommended childhood-immunization schedule from the Centers for Disease Control (CDC) Website.” The goal of the exercises was to reinforce the participants' newly acquired skills from the class. They were to take the exercises home and complete them at their leisure. Contact information for the librarian instructors was provided on the handouts, and participants were encouraged to use the contact information if they had questions about class or the learning exercises.
DATA COLLECTION
The librarian instructors collected data through a preclass survey, a class evaluation, and an impact survey. All of the data were collected with anonymous forms. The preclass survey and impact survey (Appendix B) were identical and consisted of seven questions about the participants' use of the Internet to locate quality health information. All participants completed the preclass survey and class evaluation. The impact survey was sent to the participants via U.S. mail two months after the class, with a cover letter and a self-addressed stamped envelope. Nine of the sixteen participants returned the impact survey. The class evaluation (Appendix C) collected information that pertained to the course objectives, course content, the librarian instructors, and facility and contained a comments/suggestion area.
RESULTS
All 16 participants completed the preclass survey. Of these, 75% stated that they used the Internet to find information, with 31% (5 out of 16) stating they used MEDLINEplus. Nine participants completed the impact survey; 100% stated that they now used the Internet to find information, with 8 out of the 9 (90%) stating they now used MEDLINEplus.
Compared with the preclass survey, the impact survey showed an increase in the use of the Websites MEDLINEplus and HSLS's Health Information for the Consumer, as well as an increase in overall use of the Internet to locate health information. In the class evaluation, all of the participants agreed that the course was well organized and relevant to their needs. In the comments/suggestions area one of the responses was that the participant “will return to school and give information to teachers and other school nurses.”
CONCLUSION
The results of the impact survey show an increase in the ability of school nurses and practitioners to use the Internet to locate reliable and authoritative health information. After the successful continuing education class, HSLS offered an additional class to members of PASNAP who were not able to attend the annual conference. Ten participants registered for this free class held at the Greensburg campus of the University of Pittsburgh. The preclass and impact surveys were not given to this group of participants, just a class evaluation after class completion. According to the class evaluations, this class was well received. There are currently no plans to offer more classes to the school nurse population.
The school nurses had a wide range of computer skills, which often challenged our teaching style and slowed down the pace of the class. However, we expect that the school nurses who participated in these classes will return to their school districts better equipped to provide leadership to students and other faculty in finding health information on the Internet.
APPENDIX A—Independent Learning Exercises
Access to Electronic Health Information for School Nurses Pennsylvania Association of School Nurses and Practitioners (PASNAP).
MEDLINEplus http://www.medlineplus.gov
Locate some general information on rabies. Is there any information written in Spanish?
Locate some information on the drug ampicillin. What are some trade names for this drug?
Find out the definition of the disease term: Pink eye.
Use the Medical Encyclopedia and look up the “EAR” test.
Find out approximately how many in-patient hospital beds there are at Children's Hospital of Pittsburgh.
You have received some information from the National Institute on Deafness and other Communication Disorders and want to know more about the organization. Locate some information about the Institute.
Health Information for the Consumer Website http://www.hsls.pitt.edu/chi
Locate some general information on childhood asthma.
Use AMA Physician Select to locate a pediatrician in the 15260 zip code area.
Use NORD's Rare Disease Database to find the Duchenne Muscular Dystrophy's organizations.
Find the side effects of the drug Ritalin.
Are there any clinical trials on Attention Deficit/Hyperactivity Disorder (ADHD) in Pennsylvania?
What is the telephone number of the Healthy Baby and Healthy Kids program from the Pennsylvania Department of Health?
Locate the recommended childhood immunization schedule from the Centers for Disease Control's (CDC) Website.
APPENDIX B
Preclass and Impact Surveys
APPENDIX C
Class Evaluation
Footnotes
* Supported in part by the National Library of Medicine under a contract (N01-LM-6-3521) with the New York Academy of Medicine.
† Based on a presentation at the 102nd Annual Meeting of the Medical Library Association, Dallas, Texas; May 22, 2002.
‡ The University of Pittsburgh Health Sciences Library System of Health Information for the Consumer Website can be viewed at http://www.hsls.pitt.edu/chi.
§ MEDLINEplus can be viewed at http://medlineplus.gov.
** Bandaids and Blackboards can be viewed at http://www.faculty.fairfield.edu/fleitas/contents.html.
†† The peanut-allergy Website can be viewed at http://www.peanutallergy.com.
‡‡ The Centers for Disease Control and Prevention Website can be viewed at http://www.cdc.gov; the Office of National Drug Control Policy can be viewed at http://whitehousedrugpolicy.gov; and ``Early Warning Timely Response: A Guide to Safe Schools'' can be viewed http://www.ed.gov/offices/OSERS/OSEP/Products/earlywrn.html.
§§ The National Pediculosis Association Website can be viewed at http://www.headlice.org.
*** The National Center for Tobacco-Free Kids Website can be viewed at http://www.tobaccofreekids.org.
Contributor Information
Amy L. Gregg, Email: agregg@pitt.edu.
Jody A. Wozar, Email: jwozar@pitt.edu.
REFERENCES
- Pennsylvania Association of School Nurses and Practitioners. [Web document]. The Association, 2002. [cited 23 Mar 2002]. <http://www.pasnap.org/history.htm>. [Google Scholar]
- Pennsylvania Association of School Nurses and Practitioners. [Web document]. The Association, 2002. [cited 23 Jul 2002]. <http://www.pasnap.org>. [Google Scholar]
- National Association of School Nurses. [Web document]. The Association, 2002. [cited 24 Jul 2002]. <http://www.nasn.org>. [Google Scholar]
- American Academy of Pediatrics. Committee on School Health. The role of the school nurse in providing school health services. Pediatrics. 2001 Nov; 108(5):1231–2. [DOI] [PubMed] [Google Scholar]
- The Pennsylvania Code. [Web document]. [cited 24 Jul 2002]. <http://www.pacode.com/secure/data/022/chapter51/s51.20.html>. [Google Scholar]
- Humphries J. The school nurse and health education in the classroom. Nurs Stand. 2002 Jan 9–15; 6(17):42–45. [DOI] [PubMed] [Google Scholar]
- Office of Disease Prevention and Health Promotion. Healthy people 2010: understanding and improving health. v.1 [Web document]. [cited 11 Apr 2002]. <http://www.healthypeople.gov/Document/HTML/Volume1/cover.htm>. [Google Scholar]
- PSNA School Nursing Position Statement Update. [Web document]. The Association, 2002. [cited 10 May 2002]. <http://www.psna.org/Practice/snupdate.htm>. [Google Scholar]