Exploring the School Nurse's Knowledge, Experiences, and Role in Trauma-Informed Care: Implications for School Nurse Practice

Abstract

School nurses as the only health care professional in schools with the potential to be in daily contact with students are in a critical position to create awareness, influence action, and provide leadership in trauma-informed care (TIC). However, there is a lack of research regarding school nurse TIC knowledge, experiences, and role in school health practice. Research has asserted the pervasiveness of Adverse Childhood Experiences (ACEs) in society as well as, it's potential to cause deleterious life-long health, educational, social, and economic outcomes (Bethell et al., 2017; Felitti et al., 1998; Stevens, 2019). Exploring the school nurse's role in TIC practice can serve as a valuable starting point for development of creative interventional strategies that can impact school nurse TIC practice self-efficacy with the potential to decrease future healthcare costs and improve student health and educational outcomes. The purpose of this study was to explore the school nurse's knowledge, experiences, and role in trauma-informed care in school health practice. This study was conducted in North Carolina using a quantitative, descriptive, design which used data collected from a purposive sample of 165 school nurses, recruited from the School Nurses Association of North Carolina (SNANC) website and snowball sampling. Participants took a 62-item online survey measuring TIC knowledge, experiences, and roles of school nurses in school health practice. Results from the descriptive statistics indicated that 60% of school nurses felt that they had adequate knowledge of trauma-informed care while 41% felt that they had an adequate ability to assess and intervene in trauma-informed care. Additionally, the main source of school nurse trauma-informed care training was from continuing education programs and on-the-job-training. School nurses indicated feeling least confident about providing trauma-related interventions including counseling and behavioral interventions to students. School nurses identified the most significant barrier to implementing TIC practices as insufficient time. Finally, it was indicated that 13% of the students seen in a typical school year were identified by the school nurse participants as having been exposed to a potential traumatic event. Implications for school nurse practice call for integration of TIC practice due to the prevalence of ACEs in the students that school nurses interact with daily. School nurse continued professional development in TIC practice as well as, advocacy for community and systemic change is essential.