Characteristics Associated With School Nurse Childhood Obesity Prevention Practices

Susan B. Quelly


Pediatr Nurs. 2017;43(4):193-199. 

In This Article


Approximately one in three children in the United States (U.S.) is overweight or obese (Ogden, Carroll, Kit, & Flegal, 2012), putting them at an increased risk for multiple physical and psychosocial comorbidities, such as hypertension, type 2 diabetes mellitus, and depression (Estrada et al., 2014). Obese children are also at higher risk to become obese adults with additional comorbidities (Biro & Wien, 2010) that will escalate this health crisis.

The school setting is an ideal environment to implement interventions and policies to prevent childhood obesity because 95% of children spend substantial time in schools where they can be physically active and consume much of their daily nutrition (Centers for Disease Control and Prevention [CDC], 2008). Recommendations by the Institute of Medicine (IOM) (2012) to expand the role of healthcare providers and focus on schools to prevent obesity support efforts to increase school nurse participation in COP. The National Association of School Nurses (NASN) (2014) states that school nurses have the expertise and background to promote COP. A finding that further supports the importance of school nurse involvement in COP asserts that a reduction in the percentage of obese children was associated with increased school nurse activities (O'Brien, 2012). School nurse participation in COP practices varies considerably (Hendershot, Telljohann, Price, Dake, & Mosca, 2008; Kubik, Story, & Davey, 2007; Moyers, Bugle, & Jackson, 2005; Nauta, Byrne, & Wesley, 2009; Quelly, 2014). Therefore, it is essential to identify characteristics linked to school nurse COP practices to develop and target interventions to promote school nurse involvement.

Nurse Characteristics Related To Nursing Practices

When exploring the issue of personal, professional, and job-related characteristics, little is known about their association with school nurses' job performances. However, the literature includes significant associations between specific nursing practices and personal, professional, and job-related characteristics of nurses working outside the specialty of school nursing and childhood obesity prevention practices (Bourgault et al., 2014; Fasolino & Snyder, 2012; Lin, Chang, Chang, & Lou, 2011; Roch, Dubois, & Clarke, 2014; Zhu, Norman, & While, 2013). Likewise, comparable characteristics of school nurses were linked to some of their nursing practices, such as performance of asthma management behaviors (Quaranta, 2013) and providing services to students with diabetes, asthma, and depression (Guttu, Engelke, & Swanson, 2004). These findings suggest that similar associations between other personal, professional, and job-related characteristics of school nurses may also exist with their engagement in COP practices.

COP Practices

Variations in performing school nurse COP practices have been described as child-level and school-level (Kubik et al., 2007). Child-level COP practices are described as actions by the school nurse targeting individual students and/or their parents, and may include providing counseling for a child's weight concern, checking the blood pressure and tracking the body mass index (BMI) of an obese child, and recommending weight loss treatment for a child (Hendershot et al., 2008; Kubik et al., 2007; Moyers et al., 2005; Nauta et al., 2009; Quelly, 2014). Examples of deficits in engagement in child-level COP practices include reports of more than half of school nurses never or rarely checking the blood pressure of an overweight child or monitoring a child's weight because of a weight concern (Kubik et al., 2007).

School-level COP practices involve school nurse activities intended to benefit the entire school population. Examples of school-level COP practices by a school nurse include activities such as writing an article about healthy lifestyles for a school newsletter, actively participating on a school health council, or monitoring school nutrition practices of using food in fundraising or as rewards (Kubik et al., 2007). A lack of performing certain school-level COP practices was reported by more than two-thirds of school nurses who never or rarely assessed the nutrient quality of school meals or assessed the school physical activity practices regarding space and equipment for play before and after school (Kubik et al., 2007). The frequency that school nurses engaged in other child-level and school-level COP practices also varies greatly, and little research has been conducted to determine which characteristics are associated with this variation.