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Service Delivery Innovation Profile

Medical Center Places Nurses in Schools, Leading to Better Lifestyle Choices and Academic Performance Among Students


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Snapshot

Summary

North Mississippi Medical Center employs nurses who work at 22 elementary and middle schools in northeastern Mississippi. In addition to offering typical school nurse services related to the treatment of minor conditions, these nurses provide annual health screenings to all students, make periodic presentations on wellness in classrooms, and participate on interdisciplinary teams to improve health-related programming in the schools. Anecdotal information gathered from the nurses, teachers, parents, and students suggests that the nurses have had a meaningful, positive impact on the ability to identify health issues and on the lifestyle choices and academic performance of individual students.

Evidence Rating (What is this?)

Suggestive: The evidence consists of anecdotal reports from nurses, teachers, parents, and students on the program's impact on the ability to identify new health issues and on student lifestyle choices and academic performance.
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Developing Organizations

North Mississippi Medical Center
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Date First Implemented

1993
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Patient Population

Vulnerable Populations > Childrenend pp

Problem Addressed

Poor lifestyle choices related to nutrition and exercise often become ingrained in childhood and can lead to serious health conditions later in life, particularly for children in low-income households in rural areas. Schools represent a natural but underutilized setting to influence such lifestyle choices.
  • Poor lifestyle choices in childhood: Fewer than 25 percent of children get at least 30 minutes of physical activity daily, and fewer than 20 percent eat five servings of fruits and vegetables a day.1 Forty percent of Mississippi's youth are overweight or obese, with the vast majority reporting unhealthy dietary behaviors and inadequate levels of physical activity.2,3 Mississippi has the highest childhood obesity rate in the nation.3 Poor lifestyle choices related to physical activity and nutrition tend to persist into adulthood, with overweight children having an 80 percent chance of remaining overweight or becoming obese as adults.3
  • Leading to serious health problems, particularly among children in poor rural areas: Poor diet, physical inactivity, and overweight/obesity often lead to serious health problems, including (but not limited to) cardiovascular disease, diabetes, and certain types of cancer. Children with low socioeconomic status—particularly those in rural areas—face an especially high risk of poor health outcomes because they have limited exposure to messages related to wellness and healthy lifestyle choices.1
  • Unrealized potential of schools: As of fall 2007, more than 55 million children attended public and private elementary and secondary schools in the United States,4 making schools a natural setting for the provision of education about wellness and healthy lifestyles.3 Yet, many schools do not offer formal activities or have dedicated personnel to provide this education. For example, in the early 1990s, most schools in northeastern Mississippi did not offer any health-related services.

What They Did

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Description of the Innovative Activity

North Mississippi Medical Center employs nurses who work at 22 elementary and middle schools in northeastern Mississippi. Although the nurses provide typical school nurse services related to the treatment of minor acute conditions, their central role focuses on prevention and wellness services and education. To that end, they provide annual health screenings, make periodic presentations in classrooms, and participate on interdisciplinary teams to improve health-related programming in the schools. Key elements of the program include the following:
  • Partnership between medical center and school: The medical center provides the nurse, medical equipment, and supplies. The school commits to providing a room for the nurse with adequate lighting, heating, and cooling; a dedicated telephone line; basic furnishings; and a secure storage area for medical supplies. The superintendent of schools and the school principal also agree to give the nurse access to the classrooms so that she can make periodic presentations.
  • Health screenings of all students: Each year during the fall semester, nurses conduct health screenings of all students. They screen for issues related to vision, hearing, height and weight, and lice in all students, and for scoliosis in fifth- and sixth-grade students. Nurses re-screen students anytime they detect a problem. If the second screen is also positive, they send a note home to the child's parents with the results and a recommendation to visit the child's health care provider. When nurses detect a problem related to hearing, vision, lice, and scoliosis, parents must provide the nurse with written verification that they have followed up with a physician. In the cases of weight concerns (e.g., overweight or obesity), nurses send information home on healthy lifestyle choices and local resources related to nutrition counseling and exercise. Nurses also contact parents when they detect a chronic health issue, such as high blood pressure. Nurses have access to the medical center's electronic medical record, where they document all screening results, treatments, and other interactions for reference by health system–affiliated physicians and emergency personnel.
  • Classroom presentations on wellness: During the second semester, nurses visit all classrooms to give presentations on the importance of physical fitness, proper nutrition, good hygiene, tobacco and drug prevention, and safety. Nurses present at least three health education topics during the semester, with topics being selected in collaboration with the principal and teachers based on their sense of the particular challenges being faced by the students. Typically, the presentations emphasize nutrition and exercise. The medical center provides the curriculum and accompanying presentation materials, which are based on materials gathered from national organizations such as the National Institutes of Health, American Cancer Society, American Lung Association, and American Heart Association.
  • Participation on health and wellness councils: Several schools have formed health and wellness councils that include the school nurse, physical education staff, cafeteria personnel, and other staff. These councils develop initiatives that focus on nutrition (e.g., including healthier choices on the cafeteria menu), exercise (e.g., developing appropriate physical education activities), and other activities to make the school environment healthier.

Context of the Innovation

The North Mississippi Medical Center is part of North Mississippi Health Services, a nonprofit health system that serves 24 rural counties in northeastern Mississippi and northwestern Alabama. With 650 beds, 3,875 employees, and 277 physicians, North Mississippi Medical Center is the largest rural hospital in the country. Many residents of northeastern Mississippi have a low socioeconomic status and suffer from chronic health conditions. As noted, before implementation of this program, most schools did not offer any health-related services. The impetus for the program came from providers, who noticed that many of their adult patients suffer from conditions, such as heart disease, obesity, diabetes, and cancer, that result in part from poor lifestyle choices formed in childhood. The medical director believed that placing nurses in schools could help children establish good health habits that would serve them well as they grew into adults.

Did It Work?

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Results

Although the program has not been formally evaluated, anecdotal reports from the nurses, teachers, parents, and students suggest that the nurses have had a meaningful, positive impact on the ability to identify health issues and on the lifestyle choices and academic performance of individual students.
  • More health issues identified: In many instances, parents have contacted the director of the community health program to report that a school nurse identified an important health issue that otherwise would have gone unnoticed. Nurses have made similar reports, noting that for some children they constitute the only medical care they receive.
  • Healthier lifestyle choices: School nurses and teachers report that students seem to be embracing healthier lifestyle choices. For example, some children report having helped their parents make healthier food choices at the grocery store.
  • Better academic performance: Teachers report instances in which children who previously performed poorly have improved their attitudes about school and their grades after having had a health issue identified and resolved.
  • High satisfaction among school staff: Principals and teachers periodically call the medical center's director of community health to express their appreciation for the nurses, noting that they have helped to improve life at their school.

Evidence Rating (What is this?)

Suggestive: The evidence consists of anecdotal reports from nurses, teachers, parents, and students on the program's impact on the ability to identify new health issues and on student lifestyle choices and academic performance.

How They Did It

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Planning and Development Process

Key elements of the planning and development process included the following:
  • Discussion with doctors: The medical director talked to physicians at the medical center's free clinic (which serves indigent patients) about the needs of their pediatric clients, and learned that access to care represented a huge problem.
  • School survey: The medical center conducted a survey of schools in the Tupelo County School District to determine if schools employed nurses, their expectations of a school nurse, and whether the school might be interested in hosting a school nurse sponsored by the medical center.
  • Communication with local pediatricians: The medical director visited local pediatricians to explain the program, emphasizing that it was not intended to draw patients away from their practices, but rather to promote healthy lifestyles and uncover medical care needs.
  • Funding and board approval for pilot test: The medical director obtained board approval to pilot the program with one nurse in two schools.
  • Communication with families: The school nurse met the families of pilot school students at parent–teacher association meetings and open houses held early in the school year. The schools also sent letters to all parents explaining the program and its goals, while the medical center created press releases for the local newspaper.
  • Program expansion: After several years, the medical center expanded the program to a handful of additional schools, and then added more schools every few years until 2004, when budgetary constraints limited further expansion. With each expansion, the medical center obtained board approval for funding and communicated with area pediatricians and student families, as outlined above.

Resources Used and Skills Needed

  • Staffing: The program currently has 18 nurses in 22 elementary and middle schools in six northeastern Mississippi counties, as well as one nurse practitioner based at the medical center who provides oversight of the program (e.g., overseeing the nurses' clinical care and approving educational materials used during presentations). The medical center attempts to have one nurse serve a population of between 800 and 1,000 students. To meet this goal, several nurses work part-time at each of two smaller schools.
  • Costs: Annual program costs total approximately $1.3 million, including labor costs and basic supplies and equipment.
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Funding Sources

North Mississippi Medical Center
The North Mississippi Medical Center funds the school nurse program because of the value it brings to the community. The medical center board does not expect or require financial justification for the program. Two of the school districts involved in the program also provide some financial assistance.end fs

Tools and Other Resources

The curriculum for the school nurse classroom presentations can be obtained from the program developer upon request.

Adoption Considerations

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Getting Started with This Innovation

  • Obtain support from area pediatricians: Make clear to local pediatricians the purpose of the program, including that the intention is not to take away their patients. Communications should highlight the prevention/wellness emphasis of the program, and note that the school nurse will be identifying health problems and encouraging students to see doctors for necessary care.
  • Involve all school personnel: Program adopters should not only communicate with the county school superintendent, but also include principals and teachers in all program-related discussions and development meetings. Alienating a key constituency within the schools can create a huge stumbling block to the implementation and ongoing success of the program.
  • Communicate with parents: Ensure that the implementation process proceeds in an open, transparent manner. To that end, invite questions from parents and communicate as much program-related information as possible using different methods (e.g., letters, meetings, news outlets).

Sustaining This Innovation

  • Ensure continued funding: Although funding opportunities in the educational sector tend to be limited (especially in the current economic environment), grant funding may be available from local, regional, and/or national foundations and government agencies.

Additional Considerations

  • North Mississippi Medical Center received a 2006 Malcolm Baldrige National Quality Award.

More Information

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Contact the Innovator

Liz Dawson, MSHA, FACHE
Director, Community Health Program
North Mississippi Medical Center
820 Ridgecrest Drive
Tupelo, MS 38801
(662) 377-4013
E-mail: LDawson@nmhs.net

Innovator Disclosures

Ms. Dawson has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

U.S. Department of Commerce National Institute of Standards and Technology. Baldrige National Quality Program. 2006 Award Recipients. North Mississippi Medical Center. Available at: http://www.baldrige.nist.gov/Contacts_Profiles.htm

Footnotes

1 Action for Healthy Kids. The Learning Connection: The Value of Improving Nutrition and Physical Activity in Our Schools. October 2004. Available at: http://nepc.colorado.edu/files/CERU-0410-238-OWI.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).
2 U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. The Obesity Epidemic and Mississippi Students. Available at: http://www.msdh.state.ms.us/msdhsite/_static/43,0,289.html#page_bottom (click on link for "Obesity and Mississippi Students")
3 Obesity in Mississippi. Mississippi Department of Education Office of Healthy Schools. Available at: http://www.msdh.state.ms.us/msdhsite/_static/43,0,289.html#page_bottom (click on link for "Childhood Obesity in Mississippi")
4 U.S. Department of Education. National Center for Education Statistics. Fast Facts. Available at: http://nces.ed.gov/fastfacts/display.asp?id=65
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: December 08, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: January 29, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: December 14, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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