Mental health issues have been exacerbated by COVID-19; therefore we examined how the school nurses’ role in addressing mental health changed during the pandemic. We administered a nationwide survey in 2021, guided by the Framework for the 21st Century School Nurse, and analyzed self-reported changes in mental health interventions by school nurses. Most mental health practice changes after the start of the pandemic occurred in the care coordination (52.8%) and community/public health (45.8%) principles. An overall decrease in students visiting the school nurse’s office (39.4%) was seen, yet the frequency of students visiting with mental health concerns had increased (49.7%). Open-ended responses indicated that school nurse roles changed due to COVID-19 protocols, including decreased access to students and changes in mental health resources. These insights into the role of school nurses in addressing student mental health during public health disasters have important implications for future disaster preparedness efforts.
BakerM. W.DowerC.WinterP. B.RutherfordM. M.BettsV. T. (2019). Improving nurses’ behavioral health knowledge and skills with Mental Health First Aid. Journal for Nurses in Professional Development, 35(4), 210–214. https://doi.org/10.1097/NND.0000000000000543
2.
BergrenM. D. (2021a). Post-COVID-19: Trauma-informed care for the school community. The Journal of School Nursing, 37(3), 145–145. https://doi.org/10.1177/10598405211004709
Bradley-KlugK. L.SundmanA. N.NadeauJ.CunninghamJ.OggJ. (2010). Communication and collaboration with schools: Pediatricians’ perspectives. Journal of Applied School Psychology, 26(4), 263–281. https://doi.org/10.1080/15377903.2010.518583
5.
BroussardL.MyersR. (2010). School nurse resilience: Experiences after multiple natural disasters. The Journal of School Nursing, 26(3), 203–211. https://doi.org/10.1177/1059840509358412
6.
BroussardL.MyersR.MeauxJ. (2008). The impact of hurricanes Katrina and Rita on Louisiana school nurses. The Journal of School Nursing, 24(2), 78–82. https://doi.org/10.1177/10598405080240020501
7.
BrownJ. D.RileyA. W.WissowL. S. (2007). Identification of youth psychosocial problems during pediatric primary care visits. Administration and Policy in Mental Health and Mental Health Services Research, 34, 269–281. https://doi.org/10.1007/s10488-006-0106-7
8.
BullardJ. S.McAlisterB. S.ChiltonJ. M. (2021). COVID-19: Planning and post pandemic partnerships. NASN School Nurse, 36(2), 80–84. https://doi.org/10.1177/1942602 × 20962213
9.
CarnevaleT. (2011). An integrative review of adolescent depression screening instruments: Applicability for use by school nurses. Journal of Child and Adolescent Psychiatric Nursing, 24(1), 51–57. https://doi.org/10.1111/j.1744-6171.2010.00256.x
DaneseA.SmithP.ChitsabesanP.DubickaB. (2020). Child and adolescent mental health amidst emergencies and disasters. The British Journal of Psychiatry, 216(3), 159–162. https://doi.org/10.1192/bjp.2019.244
12.
DavisD.MaughanE. D.WhiteK. A.SlotaM. (2021). School nursing for the 21st century: Assessing scope of practice in the current workforce. The Journal of School Nursing, 37(5), 374–386. https://doi.org/10.1177/1059840519880605
13.
De BreyC.SnyderT. D.ZhangA.DillowS. A. (2021). Digest of education statistics. National Center for Education Statistics, Institute of Education Sciences, US Department of Education. https://nces.ed.gov/programs/digest
14.
GranoC. A.GavinE. M.CoganR. (2021). Through the looking glass: Reflections from three school nurses amid the COVID-19 pandemic. OJIN: The Online Journal of Issues in Nursing, 26(2). https://doi.org/10.3912/OJIN.Vol26No02Man04
15.
GreeneT.GrossR.AmselL.HovenC. W. (2018). The mental health of children and adolescents exposed to 9/11: Lessons learned and still to be learned. In World trade center pulmonary diseases and multi-organ system manifestations (pp. 121–136). Springer. https://doi.org/10.1007/978-3-319-59372-2_9
16.
GunaratnamS.AlisicE. (2017). Epidemiology of trauma and trauma-related disorders in children and adolescents. In LandoltM.CloitreMSchnyderU. (Eds.), Evidence-based treatments for trauma related disorders in children and adolescents. Springer.
17.
HillR. M.RufinoK.KurianS.SaxenaJ.SaxenaK.WilliamsL. (2021). Suicide ideation and attempts in a pediatric emergency department before and during COVID-19. Pediatrics, 147(3). https://doi.org/10.1542/peds.2020-029280
18.
HillisS. D.BlenkinsopA.VillavecesA.AnnorF. B.LiburdL.MassettiG. M., … & UnwinH. J. T. (2021). COVID-19-associated orphanhood and caregiver death in the United States. Pediatrics, 148(6), e2021053760. https://doi.org/10.1542/peds.2021-053760
19.
HolmesB. W.SheetzA.AllisonM.AnconaR.AttishaE.BeersN., … & YoungT. (2016). Role of the school nurse in providing school health services. Pediatrics, 137(6). https://doi.org/10.1542/peds.2016-0852
20.
HoskoteA. R.CroceE.JohnsonK. E. (2023). The evolution of the role of US school nurses in adolescent mental health at the individual, community, and systems level: An integrative review. The Journal of School Nursing, 39(1), 51–71. https://doi.org/10.1177/10598405211068120
21.
JamesonB. E.BowenF. (2020). Use of the worklife and levels of burnout surveys to assess the school nurse work environment. The Journal of School Nursing, 36(4), 272–282. https://doi.org/10.1177/1059840518813697
22.
KorteC.FriedbergR. D.WilgenbuschT.PaternostroJ. K.BrownK.KakoluA., … & LeykinY. (2021). Intolerance of uncertainty and health-related anxiety in youth amid the COVID-19 pandemic: Understanding and weathering the continuing storm. Journal of Clinical Psychology in Medical Settings, 29(3), 645–653. https://doi.org/10.1007/s10880-021-09816-x
23.
LeeR. L.WestS.TangA. C.ChengH. Y.ChongC. Y.ChienW. T.ChanS. W. (2021). A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals. Nursing Outlook, 69(3), 399–408. https://doi.org/10.1016/j.outlook.2020.12.003
24.
LoadesM. E.ChatburnE.Higson-SweeneyN.ReynoldsS.ShafranR.BrigdenA., … & CrawleyE. (2020). Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 1218–1239. https://doi.org/0.1016/j.jaac.2020.05.009
25.
MarrapeseB.GormleyJ. M.DescheneK. (2021). Reimagining school nursing: Lessons learned from a virtual school nurse. NASN School Nurse, 36(4), 218–225. https://doi.org/10.1177/1942602X21996432
26.
MartinssonE.GarmyP.EinbergE. L. (2021). School nurses’ experience of working in school health service during the COVID-19 pandemic in Sweden. International Journal of Environmental Research and Public Health, 18(13), 6713. https://doi.org/10.3390/ijerph18136713
27.
MasonbrinkA. R.HurleyE. (2020). Advocating for children during the COVID-19 school closures. Pediatrics, 146(3), e20201440. https://doi.org/10.1542/peds.2020-1440
28.
MaughanE. D.BoboN.ButlerS.SchantzS. (2016). Framework for 21st century school nursing practice: National association of school nurses. NASN School Nurse, 31(1), 45–53. https://doi.org/10.1177/1942602X15618644
29.
MaughanE. D.JohnsonK. H.GryfinskiJ.LamparelliW.ChathamS.Lopez-CarrascoJ. (2021). Show me the evidence: COVID-19 and school nursing in the 21st century. NASN School Nurse, 36(1), 46–51. https://doi.org/10.1177/1942602X20974770
30.
MayneS. L.HannanC.DavisM.YoungJ. F.KellyM. K.PowellM., … & FiksA. G. (2021). COVID-19 and adolescent depression and suicide risk screening outcomes. Pediatrics, 148(3), e2021051507. https://doi.org/10.1542/peds.2021-051507
31.
MilesM. B.HubermanA. M.SaldañaJ. (2020). Qualitative data analysis: A methods sourcebook, 4th ed. Sage publications.
32.
National Academies of Sciences, Engineering, and Medicine [NASEM]. (2021). The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity. The National Academies Press. https://doi.org/10.17226/25982
33.
National Association of School Nurses. (2022). School Nursing: Scope and Standards of Practice. 4th Edn. NASN.
34.
ObergC.HodgesH. R.GanderS.NathawadR.CuttsD. (2022). The impact of COVID-19 on children’s lives in the United States: Amplified inequities and a just path to recovery. Current Problems in Pediatric and Adolescent Health Care, 52(7), 101181. https://doi.org/10.1016/j.cppeds.2022.101181
35.
OkuyamaJ.FunakoshiS.TomitaH.YamaguchiT.MatsuokaH. (2017). Mental health and school-based intervention among adolescent exposed to the 2011 Great East Japan Earthquake and Tsunami. International Journal of Disaster Risk Reduction, 24, 183–188. https://doi.org/10.1016/j.ijdrr.2017.06.012
36.
PowellS. B.EngelkeM. K.SwansonM. S. (2018). Moral distress among school nurses. The Journal of School Nursing, 34(5), 390–397. https://doi.org/10.1177/1059840517704965
37.
PurvisK. B.CrossD. R.DansereauD. F.ParrisS. R. (2013). Trust-based relational intervention (TBRI): A systemic approach to complex developmental trauma. Child & Youth Services, 34(4), 360–386. https://doi.org/10.1080/0145935X.2013.859906
RacineN.McArthurB. A.CookeJ. E.EirichR.ZhuJ.MadiganS. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis. JAMA Pediatrics, 175(11), 1142–1150. https://doi.org/10.1001/jamapediatrics.2021.2482
40.
RauW.LytleM. (2020). The role of the school nurse in increasing instructional time using multi-tiered systems of support for behavior (MTSS-B): A quality improvement project. NASN School Nurse, 35(5), 276–283. https://doi.org/10.1177/1942602X20942492
SendallM.FlemingM.LidstoneJ.DomocolM. (2014). School based youth health nurses and attrition: The reasons for moving on. Community Practitioner: The Journal of the Community Practitioners’ & Health Visitors’ Association, 87(8), 30–34. https://eprints.qut.edu.au/75310/
43.
SimmonsN. (2017). Axial coding. In AllenM. (Ed.), The SAGE encyclopedia of communication research methods (Vol. 1, pp. 80–82). Sage Publications, Inc, https://dx.https://doi.org/10.4135/9781483381411.n33
44.
SonesonE.HowarthE.FordT.HumphreyA.JonesP. B.Thompson CoonJ., … & AndersonJ. K. (2020). Feasibility of school-based identification of children and adolescents experiencing, or at-risk of developing, mental health difficulties: A systematic review. Prevention Science, 21(5), 581–603. https://doi.org/10.1007/s11121-020-01095-6
45.
TaylorS. (2019). The psychology of pandemics: Preparing for the next global outbreak of infectious disease. Cambridge Scholars Publishing.
46.
WillgerodtM. A.BrockD. M.MaughanE. D. (2018). Public school nursing practice in the United States. The Journal of School Nursing, 34(3), 232–244. https://doi.org/10.1177/1059840517752456
47.
ZhouS. J.ZhangL. G.WangL. L.GuoZ. C.WangJ. Q.ChenJ. C., … & ChenJ. X. (2020). Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. European Child & Adolescent Psychiatry, 29(6), 749–758. https://doi.org/10.1007/s00787-020-01541-4
