This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Ryan, K. M. Search for Related Content PubMed Articles by Ryan, K. M. Social Bookmarking                         What's this?

Health Promotion of Faculty and Staff: The School Nurse’s Role

Kelly M. Ryan, RN, MSN, is a school nurse in Mount Carmel Area Elementary School, Mount Carmel, PA

	Abstract

Top Abstract REVIEW OF LITERATURE IMPLEMENTATION OF A HEALTH... IMPLICATIONS FOR SCHOOL NURSING... REFERENCES

 
Health promotion of school faculty and staff is an important part of a coordinated school health program. The lack of evaluation of health promotion programs and inconsistent results highlighting the efficacy and benefits of programs adds to employers’ perceptions of inconsistent benefits. More studies evaluating effectiveness and development of standards for health promotion programs must be conducted. The steps essential to a successful health promotion program are assessment of the target population’s needs, planning, implementation, and evaluation of the health promotion program. School nurses are one of many groups who must be involved in the development of health promotion programs for school faculty and staff. Collaboration with other school personnel, administration, and community resources is essential to the success of a health promotion program.

Key Words: coordinated school health program • staff wellness programs • health promotion • program planning • school nursing

The role of the school nurse is multifaceted. Most activities clearly identified as the domain of school nursing practice are directly related to students, such as providing screenings, health education, care of students with chronic illnesses and special needs, as well as injury prevention. A less known but no less important aspect of the role of the school nurse is health promotion for faculty and staff in the school setting. The National Association of School Nurses (NASN; 2006) Issue Brief: School Health Nursing Services Role in Health Care: Health Promotion and Disease Prevention discusses the need for primary prevention and health teaching to all members of the school community. Health promotion is targeted at reducing or changing modifiable health risks, such unhealthy diet, lack of exercise, irresponsible sexual practices, and substance use. Another goal of health promotion is reduction of health care costs, including indirect costs related to missed work and work-related injuries. The purpose of this article is to discuss the need for faculty and staff health promotion in the school setting and to outline the steps in developing, implementing, and evaluating a faculty and staff health promotion program.

	REVIEW OF LITERATURE

Top Abstract REVIEW OF LITERATURE IMPLEMENTATION OF A HEALTH... IMPLICATIONS FOR SCHOOL NURSING... REFERENCES

 
There is little literature related to the effectiveness of school health promotion programs for faculty and staff. This may be because of a lack of formalized health promotion activities in the school (Galemore, 2000), as well as a lack of evaluation of program outcomes. Overall, there has been an increase in the number of employer-sponsored health promotion programs in the workplace since the 1970s (Grunbaum, Rutman, & Sathrum, 2001). This increase is a reflection of the value placed on health by both employers and employees and the recognition that reducing modifiable risk factors and assisting employees in behavior modification are effective methods to increase productivity, reduce workplace injuries, and reduce health care costs for employers.

"Reducing modifiable risk factors and assisting employees in behavior modification are effective methods to increase productivity, reduce workplace injuries, and reduce health care costs for employers."

Research related to the effectiveness of employer-sponsored health promotion programs is limited and often shows inconsistent results. Musich, Adams, and Edington (2000) conducted a study of 1,272 individuals in a long-term (6 years) health promotion program. There were two groups: One participated in a limited program (n = 645) and the other participated in a comprehensive program (n = 627). All participants were offered a health risk appraisal (HRA) on a yearly basis. The HRA included demographic characteristics, four psychological variables, six lifestyle variables, and five health/biological variables. The HRA was developed by the Centers for Disease Control and Prevention (CDC) and modified by the University of Michigan Health Management Research Center for the project. At the conclusion of the 6-year program, participants with more health risks had incurred more health care costs than participants with fewer health risks. In addition, health care expenditures were highest in the limited participation group and among those with the highest number of health risks.

Grunbaum et al. (2001) analyzed data from the School Health Policies and Programs (SHPPS) study of 2000. Data related to faculty and staff health promotion were collected from 49 states and the District of Columbia. Areas addressed were the presence of policies and procedures related to physical examinations and screenings for faculty and staff, health promotion activities and services, the presence of employee assistance programs, and the coordination of health promotion activities. Findings indicated that one quarter of states and one third of school districts required physical examinations and half of the school districts required tuberculosis screening for employees. Few school districts required periodic physical examinations beyond the initial physical examination for employment. Very few states required schools to provide employee screening for health, vision, height and weight, or diabetes.

According to the SHPPS survey data, collaborators in health promotion activities included local hospitals, local health departments, and other health-related organizations such as the American Cancer Society. The data also showed that school districts take into consideration many factors and goals when planning health promotion activities. These include improving faculty and staff morale, creating a healthy school environment with healthy role models for students, decreasing the number of sick days for faculty and staff, reducing insurance costs, as well as reducing the number of injuries among school faculty and staff (Grunbaum et al., 2001).

Schools with health or wellness councils were more likely to offer health promotion and education to faculty and staff (Brener, Kann, McManus, Stevenson, & Wooley, 2004). These schools were also more apt to have a faculty and staff health promotion coordinator and offer physical activity programs, employee assistance programs, and health screenings for faculty and staff. Although these results are informative, there was no correlation between the presence of health promotion programs and outcomes associated with these programs.

According to Thorpe (2005), employers have implemented health promotion programs to encourage weight loss, encourage changes in dietary intake, and reduce stress in employees. A review of literature indicated a savings of $3.93 for every dollar spent on health promotion or health education activities provided to employees. However, the varying designs and degrees of comprehensiveness of programs make it difficult to determine the effectiveness of work-site health promotion programs. Lack of standardization of health promotion programs makes it difficult to determine what program features actually promote the greatest health behavior changes as well as the greatest cost savings for employers.

"A review of literature indicated a savings of $3.93 for every dollar spent on health promotion or health education activities provided to employees."

Only 30% of employers offer health promotion programs, and 10% of these programs are considered comprehensive (Thorpe, 2005). Identification of best practices for effective health promotion programs, use of CDC guidelines for a comprehensive health promotion program, and the creation of government incentives for employers to offer comprehensive employee health promotion programs would increase the number and effectiveness of employee health promotion programs. The goal of these programs is to improve employee health and decrease health care spending.

Richardson (1998) reported that many employers’ state that time and monetary concerns are barriers to implementation and evaluation of health promotion programs. They tend to overlook the need for or the benefits of such programs because of the cost or lack of perceived need. Cost alone cannot be the sole determinant of the value or benefit of a health promotion program: Programs must be evaluated in terms of effectiveness. The evaluation of health promotion programs should be done in two separate contexts. The first is the measurement of the benefit to the participants, both perceived and actual, such as better health as measured by, for example, decreases in weight and blood pressure, as well as participants’ perceived increase in health or healthy behaviors. The second measurement of effectiveness is monetary savings, such as reduction in health care costs for employees, workers’ compensation, and absenteeism. By using both outcome indicators, employers are assured of a program that is both cost effective and beneficial to their employees.

Healthy People 2010 is a 10-year health promotion program for improving the health of all Americans. Focus area seven is related to education and community-based programs and has supporting data related specifically to work-site health promotion programs. In 2000, 53% of employers employing fewer than 50 employees had a health promotion program in place. Of employers with 50 to 99 employees, 33% provided health promotion programs in 1998. That same year, 33% of employers employing from 100 to 249 employees offered a health promotion program. The number of employers with 250 to 749 employees offering health promotion activities in 1998 was 38%. The target percentage for the year 2010 is 75% for all levels of employers. The number of employees aged 18 years and older participating in employer-sponsored health promotion programs in 1994 was 59%. The target for 2010 is 88% (CDC, 2008).

In 2005, a midcourse review or evaluation of the Healthy People 2010 goals and objectives was done to document progress toward achieving the stated objectives. Some of the objectives and focus areas were revised based on the data collected. Focus area seven relating to health promotion was unchanged. The objective remains to have an increase in employer-offered comprehensive health promotion programs (U.S. Department of Health and Human Services [USDHHS], 2005). In the midcourse review, health promotion activities offered by employers with fewer than 50 employees increased to 34%, up 1% from 2000. Health promotion programs offered by employers having from 50 to 99 employees remained at 33%, as did programs offers by employers with 100 to 249 employees. The target percentage for the Healthy People 2010 objectives for employers offering health promotion programs remains unchanged at 75%. According to the Healthy People 2010 Midcourse Review, the number of employees age 18 and older participating in employer-sponsored health promotion programs was 67%; the target remains unchanged at 88% (USDHHS, 2005).

School Nursing: Scope and Standards of Practice (NASN & American Nurses Association, 2005) identifies specific areas of competency for school nurses related to health education. School nurses should participate in the assessment of the needs of the school community related to health education, provide health instruction both on the individual and group level, assist in the design and implementation of health education curricula, and participate in the evaluation of health education programs. In addition, school nurses are an excellent resource for faculty and staff health education. They can also assist with the implementation of health promotion activities throughout all areas of the school community and promote self-care through education about potential health problems or illnesses.

Public schools are one of the largest employers in the United States. In 1998, 5.4 million workers were employed in public schools (Grunbaum et al., 2001). Because of the large number of people employed in the public school system, school nurses have a unique opportunity to reach this population through work-site health promotion programs targeting faculty and staff.

"Because of the large number of people employed in the public school system, school nurses have a unique opportunity to reach this population through work-site health promotion programs targeting faculty and staff."

	IMPLEMENTATION OF A HEALTH PROMOTION PROGRAM

Top Abstract REVIEW OF LITERATURE IMPLEMENTATION OF A HEALTH... IMPLICATIONS FOR SCHOOL NURSING... REFERENCES

 
The nursing process is a useful framework for the development of a health promotion program for faculty and staff. Each of the four steps—assessment, planning, implementation, and evaluation—are essential to a successful health promotion program.

Assessment of the Target Population
During the assessment process, it is important to gather epidemiological data to determine the health problems or concerns of the target population. The assessment team should also conduct a community assessment to gather data about age, gender distribution, race, ethnicity, educational levels of community members, overall living conditions, and community organizations. Data gathering via questionnaires or focus groups may be part of the responsibilities of the school nurse alone or in collaboration with the school wellness council (Greenberg, 2004). Health data and statistics related to health problems, absenteeism, illness, or injury in the target population are helpful in justifying the need for the program to various stakeholders. At the conclusion of the assessment process, identified needs will direct the program planning process.

Planning
Once specific needs in the target population have been identified, the program planning process begins. The identified needs will determine the focus of the program. Overall goals and specific measurable objectives need to be clearly stated at the beginning of the planning process. Next, an action plan must be developed with a general time line for completion of tasks as well as identification of needed resources.

The school nurse and planning team should identify key people, organizations, and other resources that will be of assistance during program planning, implementation, and evaluation. In addition, the team needs to explore which educational strategies have been effective with the intended population and designated content. It is important to consider cultural beliefs and practices of the target population when considering program strategies (Central Sydney Area Health Service & NSW Health, 1994).

Program funding is an important consideration during the planning phase. Identifying funding sources, facilities, equipment, presenters/educators, developing a schedule for the program and marketing the program are all necessary parts of program planning (Greenberg, 2004). Funds may be obtained through the school health budget or external grant funding. The team along with the school nurse can write a grant to secure funds for health promotion and wellness programs. Grants may be available through local community-based organizations, such as the American Red Cross or Lions Club, through state agencies, or national organizations that offer grant funds to organizations. Many organizations have a list of available grants and funding agencies whose goals are consistent with workplace health promotion programs. Outlining how the program’s goals and objectives will be measured is essential when grant funds are being sought. Funding agencies will require written demonstration that the program has met its goals and objectives to justify the funds granted. These data are particularly helpful when seeking a continuation of funding or new funding.

The development of measurement tools to determine the effectiveness of health promotion programs is a difficult and often overlooked aspect of program planning. In this day of accountability, program planners need to develop a reliable method of determining the outcomes of their efforts. This often involves gathering baseline data to determine participants’ health status, health behaviors, or health beliefs before the implementation of the program. Other essential baseline data may include employer records of absenteeism, workplace injuries, and health care costs. Another important consideration in the evaluation of outcomes is when the outcome will be measured. Because health promotion program goals relate to not only short-term changes but also long-term changes in health and health-related behaviors as well as reduced absenteeism and health care costs, measurement is often ongoing rather than a onetime measure at the conclusion of the program.

The identification of barriers and facilitators to program implementation are important to consider during the planning process. Barriers include varying health beliefs, cultural norms, language barriers, as well as perceived lack of buy-in by school faculty and staff. Lack of funding may be considered a barrier; however, it can be overcome by aggressively exploring various funding sources as explained previously. Facilitators may include a commitment by the school district to provide a health promotion program designed to improve faculty and staff health as well as to reduce the costs associated with staff illness and injury. The involvement of local hospitals or agencies has also been identified as a facilitating factor (Greenberg, 2004).

The planning process is the most time-consuming yet the most important part of any health promotion program. During this process, goals and objectives are formulated around assessed needs, resources are identified, funding sources are contacted, educational strategies are determined, and barriers and facilitators anticipated. Most importantly, evaluation measures to determine the effectiveness of the program are developed and in place when program implementation begins.

Implementation
Implementation of the program is where all the coordinated efforts of the health program planning team come together. Effective communication among all team members and those actually carrying out the program is essential for a smooth running program. Key players should be assigned to monitor the program progress, budget, and use of resources (Central Sydney Area Health Service & NSW Health, 1994). The school nurse may be involved in delivering health education or participating in other program components. A well-developed relationship and rapport with coworkers as well as knowledge of health-related issues is an asset the school nurse brings to the program. The school nurse can also assist in coordination of various aspects of the program as well as supporting and encouraging staff in making recommended health behavior changes.

Evaluation
Evaluation is a crucial component of any health education program. As mentioned previously, goals and objects for the program are clearly articulated in the planning stage. These form the basis for evaluation of outcomes of the programs and answer the question, "Did the program meet the intended goals and objectives?" Data must be gathered prior to the implementation of the program to provide the baseline needed for comparison at the completion of the program (Greenberg, 2004).

Evaluation should measure in a very concrete manner the effectiveness of the program as stated in the objectives. Particularly valuable are measures that show changes in health (such as decreased weight, blood pressure, cholesterol, or stress), or in health behaviors (such as exercising regularly or getting more sleep), in addition to the traditional measures of increased knowledge as a result of attending an educational program. Important outcomes for employers include decreased staff absenteeism, decreased injuries, and decreased health care costs. Being able to demonstrate desired outcomes will help planners in continuing or building on their programs as well as securing funding for future programs. The biggest benefit, however, is improved health for faculty and staff (Wainwright, Thomas, & Jones, 2000) and the cost saving to the school district that can be used for other educational endeavors.

The school environment presents many opportunities for participating in research related to health promotion programs for faculty and staff. Research that demonstrates the effectiveness of such programs is much needed in the school health literature. Detailed descriptions of programs that work are essential so that school nurses have knowledge of specific program components that should be incorporated in health promotion programs to insure success. Outcome data are crucial as school nursing moves toward evidence-based practice.

	IMPLICATIONS FOR SCHOOL NURSING PRACTICE

Top Abstract REVIEW OF LITERATURE IMPLEMENTATION OF A HEALTH... IMPLICATIONS FOR SCHOOL NURSING... REFERENCES

 
There are many directions that school nurses can take in developing a health promotion program for faculty and staff. They can use the focus areas of the Healthy People 2010 objectives in deciding on potential topics for the curriculum. Areas of importance include providing information about recognizing the symptoms of stroke and heart attack; CPR and first aid training; blood pressure and cholesterol screening; teaching the importance of increasing fruit, grain, and vegetable intake; and increasing the amount of deliberate physical activity (CDC, 2008).

The school environment allows school nurses to interact with a large number of diverse individuals. Parents, students, faculty, staff, community leaders, and other health care providers in the community may be valuable resources as well as potential collaborators in the planning and implementation of a workplace health promotion program (Bradley, 1997). By taking a greater interest in their own health and fitness, teachers may become interested in the health and wellness of their students and become role models for healthy lifestyles. Teachers involved in a health promotion program will gain an increased understanding of the health needs and concerns of their students and their parents (Allegrante, 1998). With their knowledge about health and interaction with coworkers and community leaders, school nurses also serve as an example to those around them by exhibiting healthy lifestyle behaviors (Denehy, 2008).

School nurses are uniquely qualified to collaborate with others in planning, implementing, and evaluating a staff health promotion program. Their involvement in the program is multifaceted. Activities may include gathering data for a needs assessment, program planning, obtaining funding, collaborating with others in the community to provide services, implementing education programs, gathering outcome data, and serving as a role model for health for those in the school environment.

Participating or assisting in the development of research on the effectiveness of health promotion programs is an important role in furthering school nursing practice. Identifying best practices and strategies for effective health promotion programs is much needed in the literature. Improving the health of faculty and staff in the school settings is an opportunity and a challenge for school nurses. Working toward meeting the Healthy People 2010 objectives for workplace wellness is an important contribution school nurses can make to the health of their school community.

	REFERENCES

Top Abstract REVIEW OF LITERATURE IMPLEMENTATION OF A HEALTH... IMPLICATIONS FOR SCHOOL NURSING... REFERENCES

 
Allegrante, JP. (1998). School site health promotion for faculty and staff: A key component of the coordinated school health program. Journal of School Health, 68(5), 190-195[Medline] [Order article via Infotrieve]

The Journal of School Nursing, Vol. 24, No. 4, 183-189 (2008)
DOI: 10.1177/1059840508319551


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Ryan, K. M. Search for Related Content PubMed Articles by Ryan, K. M. Social Bookmarking                         What's this?