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Individualized Data Improvement Plan

Kate Mirth

Ashland University

SNP 525


A School Nurse, huh? What exactly does a school nurse do? Bandaids and ice packs?

Well, yes. School nurses certainly apply plenty of bandaids and boo-boo packs however, school

nurses are an invaluable member of the school's interdisciplinary team. The proof is in the

pudding you say? Well, we have a plan for that! Data collection is a key element in applying

evidence-based practice and provides records of interventions and related outcomes. In other

words, data collections show stakeholders what we do! The use of data can be used to inform

stakeholders on issues to improve student health and education outcomes, indicate the need for

additional nursing positions and help identify and develop health policies (Lepkowski, 2018).

An integrative review conducted by N.Best revealed: "creating a database of school nursing

interventions with standard definitions and outcome measures can advance school nursing

science by helping researchers learn from each other, which will also build the opportunity of

more sophisticated analysis of results from multiple studies (Best, 2017)." The results from the

data collection assessment plan demonstrate school nurses are in a position to collect data and

use the data effectively to improve health, education and school nursing practice.

After reviewing the data collection process used with Akron Children's School Health

service, one area that I consider to be a strength is the data collection with clinic visits. The

NASN published a conceptual framework for 21st-century school nursing practice which is

student-centered and takes family and community into consideration. Collecting data on clinic

visit encompasses many parts of the NASN framework. For example, care coordination

(managing emergencies, communication with parents, post-concussion symptoms and returning

to learn), leadership (educating students and staff), quality improvement (documenting the data)

and community health (conducting screening, asthma surveillance, and sexual health) (Selekman

2019). Each day when I am collecting data at the end of the school day, I am demonstrating key

principles and components of the NASN Framework. Collecting data is apart of my daily nursing

practice. I have a daily data collection sheet and at the end of each week, I add each section to

generate a weekly summary and upload the information into REDCAp (a browser-based,

software workflow database).

Based on the daily and weekly data collection for the clinic at the High School, most of

the interventions and activities carried out can be categorized as care coordination, using the

NASN framework. Literature links the care coordination principle (school nurse interventions)

with positive student outcomes (Best, 2018). Besides, chronic disease surveillance data plays a

significant role, which includes students with chronic conditions, service provided, number of

visits to the clinic, dispositions, and absenteeism (Lepkowski, 2018).

Implementing practical, evidence-based practice to promote health and education is the

ultimate goal of data collection. During the last 2 years at high school, I've tracked OTC, PRN

medication administration. A trend emerged correlating students with menstrual cramps and

non-injury headaches​ with​ medication at school are far more likely to stay at school versus the

students who did not have medication at school. I began to collect data about the number of visits

of students with menstrual cramps and non-injury headaches, the number of times medication

was administered and the number of students who left for home versus back to class. As a result

of data collection at the high school, I began to form a PICOT question and considering what is

the best practice for adolescents and the use of over the counter pain medication for menstrual

cramps and headaches. "Collecting data in a meaningful way will reveal trends or areas of

concern among the student populations (Lepkowski, 2018)." The result of this data collection

lead to building a team to implement policy change based on evidence-based practice to provide

stock OTC medication authorized by appropriate stakeholders.

As school nurses, we can continue to build on data collection using the NASN framework

principle, quality improvement. We document and collect data in our daily practice to

systematically measure outcomes and discover which interventions have the greatest impact on

health and education (Bast, 2018). School nurses must collection, analyze and report data about

the care they provide and the impact of the interventions (Dewey, 2016). "Continued strong

efforts of data collection are necessary to measure the impact of school nurse presence, intensity

and the impact of interventions on child health and education and outcomes (Dewey, 2016). "

Although collecting data on the daily health statistics of the clinic main seem laborious, a

study designed to test the feasibility of data collection in the school clinic found that on average

it took about 7.5 minutes for the nurse to collect daily data (Dewey, 2018). School nurses need to

continue to build on data collection and report student health data to advocate for the needs of

students in school settings (Selekman, 2019 p.109). When armed with data collection points we

can better identify students at risk, trends and help guide evidence-based practice. It is imperative

to continue to build on the current data collection process already in place in the district. School

nurses are change agents and through the data collection process, real and lasting changes can

successfully be achieved. Staying abreast of current best practices using the 21st Century

framework and using the national standardized data points will help guide and build on my

current practice.


After reviewing the data collection assessment chart, an area that I identified as needing

improvement was data collection for vision and hearing screening. Advocating ad facilitating

revisions to ensure compliance with state mandates to ensure screenings is the role of the school

nurse (Selkeman, 2019 p 293). Conducting vision and hearing screenings on the Junior class in

the district where I work presents with several barriers. Our first barrier, unfortunately, is

administration. The head Principal does not want students interrupted during academic class

time, of course as the RN I want kids to be in class as well. As upperclassmen, they are allowed

to apply for a "flex pass" which is a pass to leave the building to go home during study hall and

lunch. As a result, most of the 11th graders are not in the building during non-academic classes,

rendering this option not ideal. The Junior class consists of 396 students.

Educating staff and administration is a vital role of the school nurse to prepare for

screenings (Selkeman, 2019 p 293). As part of the planning process, I have met with the head

principal and assistant principal and we have discussed arranging for the junior class to have

screenings done during a government class (which is a year-long class). The assistant principal

proposed the idea and provided the teachers with several dates to choose from to help plan class

time according (i.e avoiding testing or new material day of screenings). Providing notice to

teachers in advance (weeks to months) will allow them to arrange lesson plans (Selkeman, 2019

p 293). This allows teachers to have input into the schedule to avoid confit and provides time for

RN to educate teachers of how long the screening will take and instruction to get the students to

the screening.

As part of the screening process, the RN will have a way to easily record the data.

Organized data collection is vital in the screening process (Selkeman, 2019 p 293). Successful

follow-up leads to early detection and treatment of childhood vision and hearing problems. Left

untreated, problems can lead to long-term implications and diminish the students learning

(Mattey, 2013). Before the screenings and class list will be populated using the EHR and

uploaded to a google doc spreadsheet. From here columns can be formed with student

identification, hearing (right and left ear), vision (right and left eyes) and comments (for any

notes such as glasses, contacts or underlying concerns. Documenting on large groups of students

has proven as challenging in my newly emerging school nurse role. After speaking with my

professor School Nurse Kimberly Stanislo we discussed using a color-coding system to identify

who still needs screenings, referrals or followup completed versus what students are completely

done.Which I plan to implement with the next screening.

After meeting with administration and teachers to plan according, as discussed by

Selkeman (p.293) as a key element in the successful planning of screenings, we are officially

scheduled after winter break the second week of January. I plan to add columns to my google

doc, one for "referral sent" and another for "followup-up." I also plan to initiate a color-coding

system on the google doc sheet. These changes can help keep organized and identify who needs

screened, referred or follow-ups. Keeping organized can be a daunting task, however,

organization leads to well-documented data and positive student outcomes.



Best, N.C., Oppewal, S., & Travers, D. (2017). Exploring school nurse interventions and

Education outcomes: an integrative review. ​The Journal of School Nursing, ​34(1), 14-27.

Bergren, M.D. (2016). The feasibility of collecting school nurse data. ​The Journal of School

Nursing, ​32(5), 337-346.

Kemper, A.R., Helfrich, A., Talbot, J., & Patel, N. (2012). Outcomes of an elementary

school-based vision screening program in North Carolina. ​The Journal of School

Nursing, ​28(1), 24-30.

Lepkowski, A.M. (2018). Unlocking data collection. ​NASN School Nurse, ​January, 27-28.

Mattey, B., Zein, W.M., O’Malley, D., & Naron, C. (2013). Preventing vision loss among

​ eptember,
students Through eye safety and early detection. ​NASN School Nurse, S


Selekman, J., Shannon, R., Yonkaitis, C. (2019). ​School Nursing: A Comprehensive Text​.

Philadelphia, PA: F.A. Davis Company.