A significant amount of research on the assessment, diagnosis, and treatment of ASDs has been published over the last 20 years (American Psychological Association, 2013; Rosenberg, Daniels, Law, & Kaufman, 2009). The continued increase in the prevalence rates of ASDs (1 in 68; Centers for Disease Control and Prevention [CDC], 2014) most likely has contributed to the proliferation of research. However, the field of school nursing has lagged behind other professions (e.g., psychology and education) in publishing research related to ASDs. Only one study (Strunk, 2009) that explored school nurses’ knowledge of ASDs was found. Specifically, Strunk (2009) showed that the majority of the Virginia school nurses surveyed reported having a good understanding of autism symptomology and the medications often prescribed to treat the associated symptoms (e.g., anxiety, hyperactivity, irritability, seizures, and depression). Interestingly, the survey also determined that school nurses were less knowledgeable about how to assist parents with accessing information and resources, dietary needs, and the difficult behaviors often displayed by children with ASDs. Strunk (2009) also noted that several school nurses indicated the need to be included when developing an IEP. Lastly, Strunk (2009) recommended that school nurses collaborate with school psychologists when addressing difficult behaviors of children with ASDs.
A few studies (Bellando & Lopez, 2009; Galinat et al., 2005) have been published outlining the role of school nurses when providing health care to children with ASDs. Specifically, Bellando and Lopez (2009) provided practical suggestions on the treatment of ASDs for the school nurse. These suggestions included in-depth discussions related to associated conditions (e.g., seizure disorders, gastrointestinal problems, sleep disturbances, and comorbid mental health conditions). They also outlined a step-by-step process for developing an IEP or IHP when working with children with ASDs. Galinat et al. (2005) utilized a similar approach in their article but included an in-depth discussion on family support and resources. They also addressed communication, safety, nutrition, and behavioral concerns school nurses need to be aware of when providing health care to children with ASDs.
In summary, school nurses work with all children, including children with special needs. Therefore, given the high percentage of children classified with ASDs within the school setting, it is
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surprising that minimal research has been published exploring the actual involvement and activities of school nurses when providing health care to children with ASDs. Although limited, prior research (Strunk, 2009) also suggests that school nurses have limited involvement during the development of IEPs, although they have indicated a desire to be involved. Specifically, little has been published exploring the actual training, knowledge, and experience of school nurses related to children with ASDs. There also is limited research studying school nurses nationally. Because Strunk’s (2009) study focused on school nurses in the state of Virginia, results may not be representative of school nurses nationally.
The current study utilized a national sample, with the goal of gaining a better understanding of school nurses’ training, knowledge, and experiences related to children with ASDs. Specifically, this study sought to understand (a) school nurses’ experience of the special education process related to providing services to children with ASD; (b) how involved school nurses are in the assessment and evaluation process when classifying children with ASDs; (c) and what the involvement of school nurses is once children are classified with an ASD within the school.
A total of 608 school nurses were sent an e-mail with a link to a survey exploring their involvement with children and adolescents with ASDs who were receiving special education services. The percentage of school nurses who completed the entire survey was 16.45% (n = 100). The majority of the school nurses responding were female (n = 95), with 1 male and 4 others who did not indicate gender. A large percentage indicated they were Caucasian (91%), whereas 2% (n = 2) were African American, 1% (n = 1) was Native American, and 1% (n = 1) was “other.” Five (5%) respondents did not indicate their ethnicity.
School nurses from Indiana completed the highest number of surveys (n = 20) compared with other states. In addition, Indiana had one of the highest percentages (50%) of respondents compared with the number of surveys e-mailed to each state. Wyoming (n = 12) and Ohio (n = 10) both had 10 or more school nurses responding to the survey. The majority of states had at least 2 school nurses who completed the survey. Interestingly, none of the school nurses sent e-mails in Delaware (n = 40), Kansas (n = 14), or Nevada (n = 20) completed the survey. Only 1 school nurse from Colorado completed the survey. The majority (n = 63; 63%) of school nurses surveyed held a registered nurse (RN; Bachelor of Science in Nursing [BSN], 4-yr.) license. Twenty-one percent surveyed had an Associate Degree in Nursing RN (2-yr.) or RN (3-yr.) license. A small percentage (n = 7; 7%) were licensed practical nurses, whereas only 1 was a nurse practitioner. Sixteen respondents (16%) had earned a master’s degree (advanced degree). None of the school nurses surveyed held doctoral degrees.
The largest percentage (31%) of nurses who completed the survey had worked in a school from 1 to 5 years. Approximately 18% (n = 18) of the respondents had worked in schools for more than 20 years. The majority (n = 54; 54%) of the school nurses were from rural school districts. In contrast, only 14% (n = 14) of the school nurse participants worked in urban schools, whereas 27 (27%) worked in suburban schools. Five participants did not indicate their work setting. The highest percentage of respondents came predominantly from the midwest and rural states (e.g., Indiana, Ohio, New Hampshire, and Wyoming).
The majority (76%) of school nurses were assigned to work in three or fewer school buildings. Surprisingly, 7% (n = 7) were assigned to work in five or six buildings, whereas 11% (n = 11) were assigned to work in four buildings. Forty-two percent (n = 42) of school nurses were responsible for administering medication to 30 or fewer students, which included children with ASDs as well as
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children with other classifications (e.g., attention deficit hyperactivity disorder [ADHD], emotional disability, or anxiety). Interestingly, 32% of the nurses were responsible for administering medication to 101 or more students. Of the 32%, 11% (n = 11) were responsible for administering medication to more than 751 students.
School nurses were randomly selected to participate in the study. A list of school districts for 18 states was obtained from state Department of Education websites. Then, schools districts were randomly (i.e., every other school district) selected from the list, which was in alphabetical order. The majority of school districts listed employees’ (e.g., teachers’, administrators’, staff’s, school counselors’, and school nurses’) names and e-mail addresses. However, some school districts only provided a list of names. When this occurred, the next school district on the state Department of Education list was used. In many school districts, school nurse e-mail addresses were found by searching the web pages for each school within the district. Participants were individuals listed as nurses or school nurses on each school’s website.
An e-mail was sent to each of the participants selected to receive the survey, which included a short introductory statement about the researcher and the study. A link to the study was embedded within the e-mail. The survey was maintained on the QuestionPro (2012) website. All data could only be accessed through the QuestionPro website by the survey owner using a username and password. In addition, the data were keyed directly to the owner and could only be accessed by the owner (QuestionPro, 2012).
Participants’ responses and nonresponses to the survey questions remained anonymous to the researcher. A reminder e-mail was sent once each week for 2 consecutive weeks. The data collection was limited to 4 weeks, which resulted in a total of 100 completed surveys.
A questionnaire was developed to collect demographic and descriptive data. Survey items were designed to answer the study’s research questions. Specific demographic questions were included in the survey to gather descriptive and frequency data on gender, level of education, licensure, and school setting. Additional descriptive data were collected to determine the caseloads and percentage/number of children with autism that school nurses served within the individual schools. The questionnaire also was designed to identify the amount and type of training school nurses had received in the area of ASDs and school nurses’ knowledge of the diagnostic criteria and medication used with children with ASDs.
Survey questions explored the school nurses’ experiences of the special education process related to providing services to children with ASD. In addition, the survey asked school nurses how involved they were during the assessment and evaluation process when classifying children with ASD. Finally, school nurses’ involvement once children were classified with an ASD was studied.