An Integrative Review of College Readiness Programs for Black High School Students;Opportunities for School Nurse Involvement

Abstract

Education is associated with improved health outcomes. However, fewer non-Hispanic Black Americans earn high school diplomas, baccalaureate, or advanced degrees than White Americans, placing them at higher risk for poor health outcomes. Racial disparities in education have been linked to social injustice and structural racism. Through the Framework for the 21st Century School Nursing Practice^TM, school nurses can impact academic success and college readiness for Black youth. An integrative review of the literature was conducted to describe programs to promote college readiness for Black high school students and evaluate school nurse involvement. Findings of the eighteen unique studies included in this review were: programs included mostly female participants, and most yielded improvements in students' non-cognitive skills (i.e. sense of belonging/confidence) and college knowledge. None of the programs included school nurse involvement. School nurses can advocate for anti-racist college readiness programs with intentional, asset-based approaches to position youth for success in college.

Introduction

The United States has seen an overall improvement in health outcomes over the past three decades. However, in almost all race-sex groups these gains have largely been reserved for the most educated (Sasson, 2016; Sasson & Hayward, 2019; Zajacova & Lawrence, 2018). Education is one of several social determinants of health (SDOH) which collectively contribute up to 80% of disparities in health outcomes among Black Americans (National Association of School Nurses [NASN], (National Association of School Nurses, 2017). Academic success in high school and college readiness are strong predictors of academic success and college degree attainment (Kitsantas et al., 2008). School nurses are uniquely positioned to address health equity through promoting academic success and college readiness for Black youth.

Education, Health, and Race

In 2019, only 87.2% of non-Hispanic Black Americans over the age of 25 earned at least a high school diploma, compared to 93.3% non-Hispanic White Americans (U S Department of Health & Human Services Office of Minority Health, 2021). In addition, only 22.6% of non-Hispanic Black Americans earned a baccalaureate degree or higher, and 8.6% earned a graduate or advanced professional degree as compared to 36.9% of non-Hispanic White Americans who earned a baccalaureate degree and 14.3% who earned a graduate or advanced professional degree (U S Department of Health & Human Services Office of Minority Health, 2021). In a 2018 meta-analysis of 89 manuscripts, increased education was associated with a reduced risk of obesity, smoking, and hypertension (Hamad et al., 2018). Most recently, SDOH, systemic racism, and access to care have contributed to the disproportionate number of COVID-19 related deaths in Black Americans (Centers for Disease Control and Prevention (CDC), 2020). In fact, the 2020 projected life expectancies for Black Americans were 77.0 years while life expectancies for non-Hispanic White Americans were 80.6 years (U S Department of Health & Human Services Office of Minority Health, 2021). Black Americans also experience higher rates of chronic illnesses such as heart disease, stroke, and cancer than White Americans (U S Department of Health & Human Services Office of Minority Health, 2021).

The disparities in academic success and health are not only based on race but also on gender. The National Center for Education Statistics (National Center for Education Statistics, 2019) reports that 64% of Black Americans that earn a bachelor’s degree are female. While more than half of Black males without a high school degree are either unemployed or incarcerated (Congressional Budget Office, 2016). For Black men, incarceration has been linked to several negative physical and mental effects on health after release from prison (Wildeman & Wang, 2017). Additionally, emerging literature points to the negative health implications of imprisonment on the female partners and children of incarcerated men (Wildeman & Wang, 2017). The number of Black youths that have been incarcerated is impacted by several policies, often called the School to Prison Pipeline, that disproportionately affects students of color (Aronowitz et al., 2021). For example, the Safe Streets Act funded school-based law enforcement officers but led to decreased availability of funds for wellness programs as well as the No Child Left Behind (NCLB) act of 2002 (Aronowitz et al., 2021). The NCLB act incentivized teachers to focus their instructional time on teaching content to pass standardized examinations while decreasing the amount of time they spent counseling students such as those that exhibit disruptive behavior. A recent review of the literature which described the role of school nurses to disrupt the School to Prison Pipeline called on school nurses to advocate for the interruption of the school to prison cycle. The authors challenged school nurses to advocate for increased funding for wellness programs and schoolwide programs to educate about the role of structural racism in the U.S. school system (Aronowitz et al., 2021).

Structural Racism

Racial disparities in educational and health outcomes have been linked to health inequities related to social justice such as structural racism (National Academies of Sciences, Engineering, & Medicine, 2021). Structural racism includes policies and laws which oppress racial and ethnic minority groups while providing advantages to dominant racial groups (National Academies of Sciences, Engineering, & Medicine, 2021). In addition to structural racism, Black youth are also impacted by interpersonal racism in the form of racial discrimination. Racial discrimination can be explicit (intentional threats or harassment) or implicit, called racial microaggressions (unintentional insults, slights, or invalidations) and can compound stress and poor health outcomes (Sue et al., 2019). In fact, repeated exposure to explicit and implicit racial discrimination has been characterized as a chronic state of “racial battle fatigue,” which can produce an adverse impact on behaviors over time (Smith et al., 2011). A growing body of work has examined racial socialization as a protective factor against racial battle fatigue (McHale et al., 2006; Seaton et al., 2018). Racial socialization refers to specific explicit and implicit messages used to build racial identity and racial pride, as well as share knowledge of what it means to be a member of the minoritized Black race. These messages can highlight positive cultural beliefs, values, expectations, achievements, traditions, and behaviors to prepare youth to respond to racial discrimination in society and counteract the negative effects of societal stereotypes (Jones & Neblett, 2016; Smalls, 2009) The literature on racial socialization suggests that asset-based conversations about Black culture can engender an anti-racist, positive racial identity (Neblett Jr. et al., 2012). Asset-based conversations equip youth with relevant strategies and coping skills to negotiate societal challenges (Neblett Jr. et al., 2012).

The Role of the School Nurse

Schools have a substantive impact on the future wellbeing of students’ health and educational outcomes (Kolbe, 2019). Schools are instrumental in establishing a framework of future health behaviors by incorporating physical activity instruction as well as health and physical education. A critical and established threat to high school success is school absenteeism (Allen et al., 2018). School nurses are licensed professionals working in public and private school settings to promote individual and population health (Willgerodt et al., 2018). Currently, there are an estimated 95,776 full-time equivalent school nurses of which 98.4% are female, 86.9% White, 4.8% Black/ African American, and 4% Hispanic/Latina (Willgerodt et al., 2018). The gender, racial, and ethnic diversity of school nurses is in stark contrast to the U.S. demographics of 50.8% female, 60.1% White, 18.5% Hispanic/ Latino, 13.4% Black/ African American (U.S. Census Bureau, n.d.). School nurses employ both primary and secondary prevention interventions which improve school absenteeism and high school graduation rates. For example, school nurses positively impact student attendance rates and academic success by promoting student wellness through immunization, obesity prevention, substance abuse assessment, tobacco control, asthma education, physical and emotional health, and staffing school-based health centers (Council on School Health, 2016).

The NASN developed the Framework for 21st Century School Nursing Practice^TM (hereafter referred to as ‘the Framework’) to guide school nurses using five key principles: Standards of Practice, Care Coordination, Leadership, Quality Improvement, and Community/ Public Health (National Association of School Nurses, 2017; Figure 1). Through operationalizing the Framework, school nurses can impact college readiness. Under the key principle of Care Coordination, school nurses use case management to support students who are at risk of negative outcomes and remove barriers to academic success (Gray et al., 2020). Additionally, within the key principle of Care Coordination, school nurses are called to promote student empowerment and facilitate transition planning, both of which may contribute to college readiness (National Association of School Nurses, 2017). Two of the five key principles in the Framework, Leadership and Community/ Public Health, direct school nurses to serve as catalysts for programs that address SDOH such as educational attainment through advocacy, health promotion, and disease prevention (National Association of School Nurses, 2017). Through their practice of these key principles, school nurses are poised to improve general school readiness, health, and academic outcomes for diverse student populations (Fleming, 2011).

Figure 1.

Framework for 21st Century School Nursing Practice^TM.

College Readiness

College readiness is the ability of a student to enroll and be successful in an institution of higher learning (Conley, 2012). College readiness is comprised of four key components in high school: content knowledge (i.e., knowledge of literary techniques in English), academic skills (i.e., writing, and analytic thinking), non-cognitive skills (i.e., self-monitoring, time management and self-control) and college knowledge (college norms/ culture, college admissions, and financial aid processes) (Roderick et al., 2009). Through these components, schools create a “college-going culture” that increases overall college readiness. Some college readiness indicators include study skills, time management, awareness of one’s performance, persistence, interpersonal skills, and the ability to utilize study groups (Conley, 2012). In addition, preparation for navigating the application process, financial aid, and the adjustment to the college culture (Conley, 2007; Conley, 2012).

Racial and gender disparities in academic success for Black youth are a public health concern that should be addressed to reduce education-related health disparities. In alignment with the Framework’s key principles of Leadership, Community/ Public Health, and Care Coordination, school nurses should advocate for college readiness programs and educate the school community about the role of structural racism as it relates to college readiness. A recent call for school nurses to dismantle factors, structural or systematic, that negatively impact equity highlights the importance of exploring the role of the school nurse in promoting college readiness for Black high school students (Willgerodt et al., 2021). While the positive impact of school nurses on student health and academic outcomes is established, little is known about school nurses’ impact on and involvement in college readiness for Black youth. The purposes of this integrative review of the literature are to describe existing programs that promote college readiness for Black high school students and evaluate school nurse involvement.

Methods

Our integrative review followed established guidelines for integrative reviews of the literature (Whittemore & Knafl, 2005) as well as the Preferred Reporting Items for Systematic Review and Meta-Analyses (Moher et al., 2009). A search strategy was developed with the assistance of a librarian with extensive experience conducting integrative reviews. The authors then searched four databases; ERIC, Scopus, PubMed, and CINAHL for studies published from 2001 to 2021. Although program components can be adjusted to fit the needs of the populations of interest, the starting date of 2001 was selected to identify contemporary interventions which incorporate updated progress in technology and generational perspectives. The databases and search criteria are described in Table 1.

Table 1.

Keyword Search Query Table.

Search Terms	Database	Number of Articles
("high school" AND students) AND (college OR university) AND (succeed OR success OR persistence OR readiness) AND (Black OR “African American”)	ERIC	1,180
("high school" AND students) AND (college OR university) AND (succeed OR success OR persistence OR readiness) AND (Black OR “African American”)	Scopus	193
("high school" AND students) AND (college OR university) AND (succeed OR success OR persistence OR readiness) AND (Black OR “African American”)	PubMed	73
("high school" AND students) AND (college OR university) AND (succeed OR success OR persistence OR readiness) AND (Black OR “African American”)	CINAHL	9

Study Selection and Data Extraction

This search was limited to English language and peer-reviewed journals. In addition, articles were included if: (a) they were published after 2001, (b) the primary population was high school-aged students, (c) included at least 20% Black or African American youth, and (d) included mentorship, leadership, or other programs with an end goal of college readiness. Studies were excluded if there was insufficient detail of the program components, did not report student outcomes, or the focus of the intervention was high school graduation only with no mention of college readiness. Each author was assigned one database to input the search criteria and upload the resulting articles. Duplicates were automatically removed when imported into the reviewing software Covidence (Veritas Health Innovation). Each author was then responsible for reviewing the title and abstract of each article to determine if the article was relevant, based on the inclusion criteria. Once this was completed the full articles were read and a consensus was reached for the articles to be included in the review. The following information was extracted from the selected studies: (a) authors, year published, (b) sample size, race, grade, gender, (c) title of article, (d) purpose of program, (d) program name and components, (e) school nurse involvement, (f) incorporation of antiracism or racial socialization strategies, and (g) program outcomes.

Results

The database search yielded 1,455 articles. Review of titles and abstracts, elimination of duplicates, and ineligible studies resulted in 276 full-text articles. As described in Figure 2, 258 additional articles were removed after full-text review resulting in 18 unique studies. After full-text review, one article was added that provided a detailed description of the program components of one of the 18 unique studies. A total of 18 unique studies reported in the 19 articles were included in this review. As shown in Table 2, most studies were conducted with only high school students (n = 15), and the remaining studies included a combination of both high school and middle school students, however, the primary population was high school students (n = 3). Sample sizes ranged from 6 (Adams et al., 2014) to over 1000 students (Gibbs Grey, 2018). All articles retrieved focused on Black students, but 10 articles also included Latino, Caucasian, Asian, American Indian, or biracial identifying students. Three of the 18 studies included in this review were gender specific. Forbes and Klevan (2018) included 20 males and Trawick et al. (2020) included 11 male students while Adams et al. (2014) included 6 female students. Nine of the remaining 15 studies reported gender and had an average sample size of 115 with 65% female participants. Three of the 18 articles reported on findings from GEAR-UP program (Gibbs Grey, 2018; Sianjina & Phillips, 2014; Yampolskaya et al., 2006) Most programs (n = 12) offered a summer enrichment experience. Programming also occurred during school hours (n = 9); after-school (n = 9); and Saturdays (n = 5). Programming was led by personnel from a variety of organizations including universities (n = 8); church (n = 1); community college (n = 1); hospital (n = 1) and other community-based organizations. None of the programs were led by or included school nurses. Five of the 18 studies incorporated antiracism or racial socialization strategies. These five studies included Gibbs Grey (2018), Hargrave (2015), and Vega et al. (2015) who included Critical Race Theory as an antiracism framework while Forbes and Klevan (2018) and Havlik et al. (2020) included racial pride as a racial socialization strategy.

Figure 2.

Preferred reporting items for systematic review and metaanalyses flow diagram. Moher et al. (2009).

Table 2.

Summary of the Literature Review.

Author, Year	Sample (Race, Age, Grade, Gender)*Setting	Title	Purpose	Program Components	School NurseInvolvement	Antiracism strategies(racial socialization/ intentional asset-based approaches)	Outcome
Adams et al., 2014	6 alumnae 3 Black 1 Latina 1 South Asian 1 European American 6th grade-end of high school All female participants *Out of School/ After-School Program	Long-Term Participants: A Museum Program Enhances Girls’ STEM Interest, Motivation, and Persistence	The purpose of the Lang Science Program is to guide, support, and offer resources to young women of color who may face barriers in their journey towards having a STEM career.	Lang Science Program: focuses on astrophysics with Earth and planetary science, anthropology, and biodiversity and conservation science. In high school, students participate in research projects, field trips, research labs	N/A	N/A	Program established a sense of belonging. Although many of the students were accepted into college, they faced challenges such as intimidation, feeling isolated, “competitive and cut-throat.”. However, several women said that their participation in the Lang program helped them stay in college.
Boyce et al., 2019	45 Black HS students *Summer & early dismissal after lunch Led by Georgia Institute for Technology (GT) professors, an academic leader from one of the schools (such as assistant principal), GT graduate students, and the ENGAGES program manager.	Implementation and evaluation of a biotechnology research experience for African-American high school students.	To address national needs for improving the biomedical and STEM workforce by targeting traditionally underrepresented groups to increase the numbers entering the STEM career pipeline.	ENGAGES (Engaging New Generations at Georgia Tech [GT] through Engineering and Science): offers boot camp, paid research, participation in mock interviews with mentors, mentorship, hands-on experience, Presentation prep.	N/A	N/A	ENGAGES scholars indicated satisfaction with their overall program experience (average mean of 4.5 or more, range 1–5). Scholars reported they were most satisfied with graduate mentor interactions, their laboratory assignment and experience, networking opportunities, and the GT campus.
Castro, 2021	15 Black male & female students from Cairo Junior and Senior High School (CSJHS) *In-school led by Community College	“They Sellin’ Us a Dream They Not Preparin’ Us for”: College Readiness, Dysconscious Racism, and Policy Failure in One Rural Black High School	To increase college enrollment numbers	Illinois College Career Readiness Pilot Program: remedial math and reading courses, informational sessions.	N/A	N/A Authors used Critical Race Theory as a framework to critique the program. Program did not include anti-racist components.	CJSHS students failed every education benchmark available, from standardized test scores in math and reading to attendance and graduation rates
Danner et al., 2017	26 HS seniors 96% Black (25) 1 white student 88.5% female (23) 11.5% male (3) 18.4 ± 0.7 years old *During school; Hospital-Based	Hospital-based, Multidisciplinary, youth mentoring and medical exposure program positively influences and reinforces health care career choice: "The Reach One Each One Program early Experience"	To increase decision to choose healthcare careers through hospital-based, multidisciplinary youth mentoring and medical exposure program	Reach One Each One: 11-week program that provided medical exposure and mentorship to inner underrepresented HS students, interaction with medical students faculty and hospital personnel, hospital tour, financial literacy.	N/A	N/A	100% HS graduation rate of participants: 92.3% (24) attending college 87.5% (21) majoring in health science 66.7% (16) pre-med ROEO had a positive impact on lives and decisions on careers in healthcare
Forbes & Klevan, 2018	20 Black/Latino male high school students *After-school, during school, summer, Saturday during academic year.	My Brother's Keeper: Nurturing In-School Relationships for Young Men of Color in New York City	To motivate and make leaders of low performing students instead of pushing them out like most schools do when dealing with underperforming men.	Expanded Success Initiative (ESI): field trips, enrichment activities taking place outside the classroom, single-gender spaces. Allowed students to openly discuss non-school issues in their lives, create relationships with mentors (student or teacher), develop leadership skill. UMOJA/ Nia summer camping trip	N/A	Racial socialization	School performance improved, relationships with educators and peers improved, and changed the way that educators saw these once underperforming young men.
Gibbs Grey 2018	Over 1,000 participants 98% Black students 9th-grade from 6 public schools in Urban communities 50% free/reduced lunch students *University; campus visits during academic year and summer program	Reppin’ and Risin’ Above: Exploring Communities of Possibility That Affirm the College-Going Aspirations of Black Youth	To understand the experience of students and leaders in the program and the formation of “Community of Possibility”.	GEAR-UP: program is a nationally, federally funded pre-college program with the intent to increase the number of low-income students in college. Program provides academic tutoring programs, summer programs, college tours, and ACT preparation.	N/A	Used Critical Race Theory as a framework. “Counternarratives seek to dispel myths about People of Color that are often present in dominant, majoritarian narratives. Particularly as it relates to Students of Color and educational achievement, students are often positioned as void of cultures that support academic achievement,” (Grey, 2018, p. 8).	The program had a positive impact on students and helped them understand the stereotypes about Black students going to college. They were able to gain confidence and began to have counter beliefs of their belongingness and possibility of positive outcomes.
Hargrave 2015	233 Black middle-school and HS students in the Metro Area Schools 59% Females 41% Males *After-school/ University	Counter Space: Analysis of Educational Structures of an After-School Program That Fosters Black Academic Success Narratives	To evaluate the effectiveness of a pre-college STEM program designed for Black HS students to prepare them for Science, Technology, Engineering, and Mathematics careers	Growing students in Science, Technology, Engineering, and Mathematics (G-STEM): Various in-class activities, after school activities, and trips to the university. Federal grant. University-led w 3 school districts and businesses. 5-year commitment. Students who fulfill requirements earn a scholarship to Major Midwest University	N/A	Used Critical Race Theory as a framework. Counter space created by the G-STEM program structures enabled African American students to counter deficit and inferiority narratives. “Counter-narratives among G-STEM participants about who can and does excel academically and in STEM fields emerge from the counter space created by the G-STEM collective community. In the G-STEM community, teachers observe, learn, develop, support, and participate in the educational counter-stories of students of color,” (Hargrave, 2015, p. 359).	Every student that completed the program graduated HS. 92% enrolled in 4-year colleges. 8% enrolled in community colleges.
Havlik et al., 2020	19, 17-19 years old youth 11 Females 58% 8 Male 42% 18 Black 1 Latino/Hispanic/ American Indian. *During school, Monday mornings had to make up missed work. Led by university professors and research assistants	Small Groups and First-Generation College Goers (FGCS): An Intervention with African American High School Seniors	To introduce first generation college goers to aspects of college and educate them on HS persistence.	FGCS: 8- 50-min sessions Help participants identify potential strengths and challenges related to college in a small group session. Provide a safe space where participants could engage in open dialogue and help them identify internal and external resources they could access when in college ie support groups & financial aid	N/A	Racial socialization	Enhanced beliefs that they could be successful in college, participants valued the group format, and participants recognized the importance of having systems of support.
Hubbard, 2005	30, low-income, Black public high school students 20 Female 67% 10 Male 33% “Most” were sophomores *During school. Led by school teachers designated as AVID instructors	The Role Of Gender In Academic Achievement	To raise academic achievement among low-income and minority students	Advancement Via Individual Determination (AVID): Academic support from an AVID teacher, academic tutoring from college students, help with college application process	N/A	N/A	Mediated discriminatory practice that disqualify students (low teacher expectations & student disengagement) from college track. Graduated high school, went on to 2 or 4-year colleges. Females went to college to earn a degree; males went to college to play sports. Females supported each other to succeed through coaching; males supported each other through sports.
Kuykendall & Barrett, 2021	49, 9-12 grade Black students *Saturday academy during the academic year and 3-week summer bridge session	Growth of Innovation: Saturday Academies	To improve educational achievement of all Pulaski County Special School District students with special emphasis on improving academic performance of Black and other at-risk students	Donaldson Saturday Scholars Academy: 8- all day sessions ACT prep, civility training and motivational rallies with Math Olympics and Spelling Bees. Those that complete the program and enroll in a partner college receive a $10,000 scholarship	N/A	N/A	Improved ACT scores; improved academic study skills and academic self-efficacy
McKendall et al., 2014	32% Black 63% financially disadvantaged 73% 1st generation college students. The program is in 800 schools across the state. *After-school club and summer camp led by staff and faculty	The Health Sciences and Technology Academy (HSTA): an educational pipeline to address health care disparities in West Virginia	To support and promote college careers in health professions.	HTSA: After school club included: academic support, learning by doing, building success, social support, and community involvement. HSTA trained teachers to lead club and support students as they completed research projects on relevant community health topics. Summer camp- 75 h community service	N/A	N/A	HSTA program graduates pursued a secondary education and most majored in STEM. 96% Attend College 90% Graduate with 4-year degree 65% major in stem 59% Health professions major
Patel et al., 2017	593 HS students, 77% minority from a medically underserved, county with high percentages of Black youth interested in pursuing a health career in underserved community. (Exact % Black participants not stated) From 4 Alabama counties (Black Belt): Tuscaloosa, Greene, Dallas, and Wilcox. *In- school enrichment program w/ 3-day summer enrichment	Area Health Education Center (AHEC) programs for rural and underrepresented minority students in the Alabama Black Belt	To evaluate West Central Alabama Area Health Education Center programs for HS students.	AHEC Path: 1) Get Em 2) Train Em 3) Keep Em and included: ACT prep, FAFSA program, College career readiness Pharmacy, Dentistry, Public health, Nursing, Medicine, and Nutrition/geriatric sensitivity training. 3-day Summer enrichment	N/A	N/A	Student satisfaction was assessed: all components had ratings of 4 or higher on a scale of 5 in both presentation content and presenter’s delivery.
Sianjina & Phillips, 2014	124 high school students 48.4% Black 51.6% White 62.1% Female 37.9% Male * After school, weekend, and summer camp	African Americans' Participation in a Comprehensive Intervention College Prep Program	To examine the college prep program, GEAR-UP	GEAR-UP: weekend PSAT/SAT instruction, Academic Summer Kamp (ASK) program, and tutoring during after-school mentor programs	N/A	N/A	59 students participated in the program, however, little or no participation was reported in the after-school mentoring program, so it was discontinued early. White students’ PSAT scores were higher than the Black students. For Black students, no significant differences were found in gains for PSAT verbal scores or PSAT writing scores, but participants gained significantly more in their PSAT math scores - Participating Black students had significantly higher-grade point averages than did non-participants
Timmermans & Booker, 2006	467 7th-12th grade Black youth from 19 urban churches *Urban churches and Christian college; Out of school church activities throughout the academic year; 4-week summer intensive college preparatory experience	College-Church Partnerships and Pre-College Programs: College Entry and Urban At-Risk Youth	To increase the college entry rate of at-risk Black youth.	College-Church partnerships and Pre College Programs: offered two sets of precollege activities: 1) building awareness of college opportunities and positive peer support, 2) home- work assistance, computer training, motivational presentations, and assistance with college searches and completing admissions and financial aid forms	N/A	N/A	Youth from less impoverished areas chose 4-year schools and those from more impoverished schools chose 2-year schools. -The study failed to reject the null hypothesis: participating nominally (four or less activities) or participating more was unrelated to college entry
Trawick et al. 2020	11 Black males enrolled in program (cohort 1) Then 16 in cohort 2 Black males recruited from 11th grade in Atlanta Public School and Fulton County School *Saturday academy; summer program; led by Morehouse faculty	K-12 DREAMS to Teach Program at Morehouse College: Challenges and Opportunities Creating the Next Generation of African American Male STEM Teachers	To prepare Black male students for careers as secondary science and math teachers at Morehouse college	DREAMS to Teach: Six-week summer program during junior year. Saturday academy during senior year. Program included tutoring and financial support.	N/A	N/A	88% of participants pursue STEM in college 62% committed to teach K-12
Vega et al., 2015	20 students from 6 public high schools in the Midwest 12 female 60% 8 male 40% 10 Black 8 Latino 2 biracial *Weekly in-school meetings; Summer Institute	Who Really Cares? Urban Youths' Perceptions of Parental and Programmatic Support	To support students in their preparation for college and provide opportunities for students to succeed academically in high school and college.	The Upward Bound Program: offers academic instruction in math, science, language arts, and foreign languages. A small stipend, college visits, and community service projects are also offered to the students	N/A	Used Critical Race Theory as a framework. “the participants consistently mentioned how relationships and support from people, such as their family members and the Upward Bound program staff, enhanced their schooling experiences,” (Vega et al., 2015, p. 62)	Participants reported staff enhanced their experiences. They motivated them to challenge themselves and helped them understand what they need to do to get into/stay in college
Winkleby et al., 2014; Crump et al., 2015	96- 11th or 12th grade low-income, students who attend public high school in Northern/Central California 50% female 50% male 23% Black 40% Latino 27% Asian 5% White 1% Native American *Summer program; led by undergraduate student staff	The Stanford Medical Youth Science Program: 18 years of a biomedical program for low-income high school students.	To link very low income, underrepresented minority high school students with science-rich resources at Stanford’s School of Medicine.	The Stanford Medical Youth Science Program’s Summer Research Program: 5-week curriculum Resources included: (1) anatomy and laboratory practicums, (2) hospital internships, (3) faculty seminars and college admission workshops, (4) research projects with a focus on public health issues, and (5) long-term college and career guidance.	N/A	N/A	99% went to college, 47% of college graduates have completed or are attending graduate or medical school, and 44 entered science or health related professions
Yampolskaya et al., 2006	475 students from Large Urban High School (HS) in Florida (29% of Student population) At-risk and low-income students (68% eligible for free or reduced lunch) 75% Black 62% Female 38% Male 49% 9th grade, 35% 10th grade, 16% 11th and 12th grade * In class, after class, on Saturdays, and during the summer	At-risk HS students in the "Gaining Early Awareness and Readiness" Program (GEAR UP): academic and behavioral outcomes.	To assess the effects of a GEAR UP intervention with at-risk HS students at a large urban HS	GEAR-UP: 5-year intervention focused on mentoring, tutoring, and counseling to promote HS graduation.	N/A	N/A	​​Improved academic performance, reduction of disciplinary problems, and improved social competence

Most of the programs offered content on careers in science/health/medicine (n = 8); other program components included student scholarship or small stipend (n = 4); content on financial literacy (n = 4) and ACT /SAT preparation (n = 3). All but one study (Castro, 2021) reported positive outcomes. Studies reported improved student belonging/belief/self-efficacy/motivation/confidence (n = 7), increased college acceptance rates (n = 6), increased high school graduation rates (n = 6), improved academic performance (n = 3), participants chose careers in STEM (n = 2), participant satisfaction with the program (n = 2), and improved ACT/ SAT scores (n = 1).

Discussion

The purpose of this integrative review of the literature was to describe existing programs that promote college readiness for Black high school students and to evaluate school nurse involvement in such programs. This integrative review identified that, to date, a greater percentage of females than males participated in the studies, when the gender of participants was reported. Most high school students in the studies included in this review were female. The underrepresentation of Black males in these college readiness programs is similar to the lack of Black males that graduate college which increases their risk of unemployment or incarceration (Congressional Budget Office, 2016). Although there were no school nurses involved in the studies included in this review, and therefore no demographic information provided, the national demographic statistics of school nurses points to the underrepresentation of both male and Black school nurses. Having school nurses that are representative of the populations they serve is vital to providing culturally relevant care and reducing health disparities (National Academies of Sciences, Engineering, & Medicine, 2021). In the absence of school nurses that are representative of the gender, racial, and ethnic diversity of the communities they serve, school nurses must take care to practice key tenets of cultural humility. These tenets include, but are not limited to, relinquishing their role as expert and embracing openness, self-awareness, self-reflection, and shared power structures (National Academies of Sciences, Engineering, & Medicine, 2021).

The one study included in this review that did not report positive outcomes (Castro, 2021) postulated that the program operated from a deficit-based framework in which the students were blamed for low performance. Alternatively, Castro (2021) suggested college readiness programs with Black youth should have an asset-based approach in which the impact of systemic racism and racial discrimination are incorporated into the intervention. The concepts of anti-racism and racial socialization were incorporated in five of the studies included in this review and align with college readiness improvements in non-cognitive skills and ability. Concepts of anti-racism and racial socialization can support a sense of belonging and confidence. Asset-based, anti-racist communications serve to relay to youth that (a) their experiences are validated, (b) they are valued as a person, (c) Black culture is associated with positive affirmations, and (d) they have support and encouragement from others (Sue et al., 2019). Further, asset-based, anti-racist communications are postulated to increase youth’s self-efficacy while also equipping them with skills and strategies to better respond to explicit and implicit racial life experiences (Sue et al., 2019).

Implications

To address gaps in academic success and education-related disparities in health, school nurses should be intentional about advocacy efforts that include Black high school males to counter the School to Prison Pipeline and the low representation of Black males that graduate college. School nurses should also advocate for college readiness programs that include an asset-based approach, and an emphasis on non-cognitive skills and ability. Program components that address non-cognitive skills should include antiracism frameworks and racial socialization which operate from an asset-based framework. Based on the Framework, school nurses are well versed in both advocacy-based leadership and cultural competency, making them well-suited to lead these efforts.

Evidence suggests that a “college-going culture” and a sense of college worthiness are important factors in college readiness (Convertino & Graboski-Bauer, 2018). To create a “college-going culture” school staff, including nurses, share their high expectations for students and outwardly demonstrate their belief that their students will be successful. They do not question whether students should attend college; rather they discuss how to prepare for post-secondary success in a variety of settings including traditionally four-year programs, community colleges, and certificate programs. Due to the close connections, school nurses have with students and the community, they are in a unique position to promote a college-going culture and college worthiness through regular daily interactions. Additionally, school climate including safety, availability of extracurricular opportunities and community building is beginning to be explored as a catalyst for college readiness. A recent review suggests that overall school climate may contribute to a college-going culture (Knight & Duncheon, 2020). School nurses positively impact school climate through a variety of activities that increase student feelings of belonging, discourage bullying, create welcoming spaces for diverse students and build community (Best et al., 2018; Garbers et al., 2018; Medina et al., 2019; Williams et al., 2018). This positive school climate can contribute to a college-going culture and the non-cognitive skills needed for college readiness (Conley, 2007; Conley, 2012).

School nurses improve student health and academic outcomes (Johnson, 2017; Yoder, 2020). While school nurses may not have the capacity to lead college readiness efforts, their expertise and position in the community can be leveraged to support academic success and college readiness for Black high school students. School nurses interact with and understand the entire school community, making them uniquely positioned to advocate for programs that meet the specific needs of the school community to facilitate student engagement, college readiness, and overall academic success (National Association of School Nurses, 2017). In partnership with key stakeholders, school nurses have the expertise to assess the components and outcomes of established college readiness programs to determine the appropriateness of use in their school communities. As public health nurses, school nurses develop deep ties with the school community (Cygan et al., 2020). For example, in a recent article Duff and Poole (2004) describe a school nurse partnership with a community-based organization, Healthy Learners, to provide comprehensive healthcare services such as vision, dental, mental health counseling, and transportation. In this program the school nurse facilitated the school/community-based organization partnership and served as the contact person for the student, parent, and Healthy Learners organization to address any barriers to access to care. Similarly, school nurses can leverage their robust relationships with the school stakeholders to partner with community-based organizations that provide college readiness programs and resources. While school nurses have the skills and expertise to contribute to college readiness for Black high school students, they remain an untapped resource in this area.

Limitations

There were several limitations to this review. First, no randomized control trials were included in this review. The studies included various designs including descriptive, cross-sectional and qualitative; incorporating a variety of methodologies can contribute to a lack of rigor, inaccuracy, and bias (Whittemore & Knafl, 2005). ​Future studies should test the effectiveness of the interventions with larger sample sizes compared to controls. Second, while some studies were excluded if they did not provide details of program components, there was variability in the level of detail in program outcomes, for example, that could be abstracted from some of the interventions included in this review. Future studies should consider tracking standard measures of college readiness such as the four components described by Roderick et al. (2009). Reporting of standard measures would improve the ability to determine the success across programs. Third, the review was targeted at Black high school students, thus the findings should not be generalized to other groups.

Conclusion

Education-related disparities in health outcomes are a public health concern. College readiness programs that include academic knowledge and skills, expose youth to college culture, norms and values as well as provide essential time management skills, can position youth for success in college. School nurses are uniquely positioned to increase college readiness through daily interactions with students and efforts to improve the school climate. School nurses can also leverage their impact on school absenteeism, and utilize their skills related to Leadership, Community/ Public Health, and Care Coordination to advocate for college readiness programs within their schools. Although the findings of this review showed the lack of school nurses’ involvement in college readiness programs, the general success of the programs included in the review is promising. There is an important and unique opportunity for school nurses to advocate for community partnerships and funding sources that provide college readiness programs to Black high school students. These programs should operate from an asset-based framework in which racial identity and culture are celebrated. School nurses should be aware of the disproportionate number of Black males that attend college and ensure they are included in programs tailored to their experiences.