Vision disorders are prevalent among preschool children and can significantly interfere with early learning, literacy development, and school readiness. Although vision screening is mandated in many states, referral completion following failed screenings remains inconsistent, particularly in underserved populations. School nurses are uniquely positioned to address this gap through structured follow-up and family-centered communication. This article describes a school nurse-led quality improvement process using the Small Steps to Eye Care Action Plan to improve referral completion for preschool students.
American Optometric Association. (2017). Comprehensive pediatric eye and vision examination: Clinical practice guideline. https://www.aoa.org/
2.
Antonio-AguirreB.BlockS. S.AsareA. O.BaldanadoK.CinerE. B.CoulterR. A.CollinsM. E. (2024). Association of sociodemographic characteristics with pediatric vision screening and eye care: An analysis of the 2021 National Survey of Children’s Health. Ophthalmology, 131(5), 611–621. https://doi.org/10.1016/j.ophtha.2023.12.005
3.
DonabedianA. (1966). Evaluating the quality of medical care. The Milbank Memorial Fund Quarterly, 44(3), 166–206. https://doi.org/10.2307/3348969
McClendonD.ZeniM. B. (2020). Evaluation of a vision referral program with school-aged children and their parents/guardians. Journal of School Nursing, 36(4), 253–262. https://doi.org/10.1177/1059840518821427
6.
MuschD. C.GillespieB. W.NiziolL. M.CashwellL. F. (2020). A community-based effort to increase the rate of follow-up eye examinations of school-age children who fail vision screenings: A randomized clinical trial. Journal of AAPOS, 24(2), 79–84. https://doi.org/10.1016/j.jaapos.2019.10.011
National Association of School Nurses (NASN). (2022). National Association of School Nurses: Scope and standards of practice (3rd ed.). American Nurses Association.
PangY.LyonsS. A.Nottingham ChaplinP. K.BlockS. S.FishmanD.CinerE. B. (2025). Recommended practices for vision screening in pre-school-age children: A 2025 update. Optometry and Vision Science, 102(10), 589–595.
12.
RodriguezE.RiveraL. M.PerlrothD.BeckerT. M. (2018). Increasing screening follow-up for vulnerable children: A partnership with school nurses. International Journal of Environmental Research and Public Health, 15(8), 1572. https://doi.org/10.3390/ijerph15081572
13.
SchlottmannH.BroderickM.LevineR.FordA. L. (2019). Nurse-led motivational interviewing to improve goal setting for obesity prevention in young children. Journal of Pediatric Health Care, 33(4), 407–414. https://doi.org/10.1016/j.pedhc.2019.02.003
14.
TuckerK.ErzurumS.KuraanT. (2024). Results of outreach referral program after failed in-school eye examinations. Ohio Journal of Public Health, 7(1), 1–8. https://doi.org/10.18061/ojph.v7i1.9904
15.
WolfeL. C.MaughanE. D.BergrenM. D. (2019). The 3S model: Student–school nurse–school community. NASN School Nurse, 34(2), 102–110. https://doi.org/10.1177/1942602X18814233
