Lisa Johnson, RN BSN University of Central Florida THE ROLE OF THE SCHOOL NURSE IN THE PREVENTION OF CHILDHOOD OBESITY AND OVERWEIGHT Lisa Johnson, RN BSN University of Central Florida

Abstract-Childhood obesity prevention Examine, develop, and define role of the school nurse in prevention of childhood obesity School nurse is in ideal position to identify, prevent, and treat overweight students Literature review examined level of nurse involvement with students Self-efficacy of families of obese students and of nurses factored into success rate of interventions Continued need for policy change and intervention measures to improve the health of the obese and overweight child

Background-childhood obesity prevention Obesity rates have continued to climb in past 30 years Risk factors include less active lifestyle, increased time in front of TV, cell phone usage, social media, and poor diets Inability of parents to see children as overweight or at risk for obesity: denial, lack of awareness/knowledge, stigma, a new “normal” (Peate, 2014) Four-fold increase in last decade in number of children and teens admitted to hospital for obesity-related conditions such as diabetes and asthma (Lepkowska, 2014)

Background-childhood obesity prevention Prevention programs: Motivational interviewing of parents conducted after identification of overweight children with BMI results in 90- 99th percentile; families willing to change habits may not have been able to incur costs and time involved; ethical dilemma of nurse in respecting family’s privacy and autonomy (Bonde et al., 2014) Effective partnerships formed with other school and health professionals to collect data such as BMI and BP to develop activity curriculum and nutritional guidelines (Bryan et al., 2013)

Background-childhood obesity prevention National Association of School Nurses (2013) lists five roles of the school nurse in ensuring the health of school children: Facilitating normal development and positive student response to interventions Providing leadership in promoting health and safety Providing quality health care and intervening with health problems Using clinical judgment in providing case management services Collaborating with others to build opportunity for self- management, self-advocacy, and learning

Problem statement-childhood obesity prevention Overweight children are at risk for developing: future health problems due to poor eating and exercise habits social and emotional suffering in the school setting Support of the school nurse, families, and other school personnel may be compromised due to feelings of inadequacy in recognizing and addressing specific needs

Significance-childhood obesity prevention Comorbidities include impaired respiratory function, asthma, heart disease, kidney disease, blindness, stroke, diabetes, hypertension, and cancer (Berquist, 2015) Predisposition to short-term and long-term adverse health risks (Wells & Cole, 2014) Gender-specific issues: infertility, polycystic ovarian syndrome, and miscarriage in females (Frisco & Weden, 2013); early-onset puberty in girls and boys Precocious puberty may cause early tooth eruption leading to crowding, dental caries, and periodontal disease (Must et al., 2012) Psychological issues: depression, anxiety, and isolation Higher health costs as a result of comorbidities of obesity

Specific aims-childhood obesity prevention School nurse will develop and/or monitor: Close relationship with child and family to initiate individualized nutritional and exercise plan Compliance of child and family Satisfaction level of child and parent Measurements of health improvements to facilitate normal child development Leadership roles within school and community

Middle range theory of self-efficacy childhood obesity prevention Theory of Self-Efficacy—Albert Bandura, PhD— 1970’s Definition: how a person judges his or her own ability to act or proceed in a certain situation (Grossklaus & Marvicsin, 2014) How parents perceive their own competence and parenting skills provided information to the school nurse in preventing childhood obesity

Application of self-efficacy theory childhood obesity prevention Self-efficacy scales measure people’s belief in their capabilities to fulfill different levels of task demands within the psychological domain selected for study (Bandura, 1989). Child Feeding Questionnaire measured parents’ perceived responsibility in feeding, weight status, and concerns about child’s weight (Grossklaus & Marvicsin, 2014) Higher self-efficacy of parents led to a healthier diet compared to parents with lower level of competence in managing their child’s diet (Grossklaus & Marvicsin, 2014) Self-efficacy of nurse had strongest influence on childhood obesity prevention (Quelly, 2014), but levels varied dependent on level of experience, role modeling, and verbal persuasion (Fisher, 2006).

Summary-childhood obesity prevention Identification of obese students, access to health information, permission, and compliance of parents necessary for successful intervention School nurses need continued involvement at all levels: family, school, community, and policy makers to ensure all measures are being taken to allow obese students to make necessary changes Goal: decrease rates of comorbidities and see improvement in all aspects of children considered obese or overweight— physically, psychologically, and socially

References-childhood obesity prevention Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. Developmental Psychology, 25(5), 729-735. Berquist, M.J. (2015). Understanding type 2 diabetes in students with obesity and the role of the school nurse. NASN School Nurse. 81-84. Retrieved from doi:10.1177/1942602x15571368 Bonde, A.H., Bentsen, P., & Hindhede, A.L. (2014). School nurses’ experiences with motivational interviewing for preventing childhood obesity. The Journal of School Nursing, 30(6), 448-455. Bryan, C., Broussard, L., & Bellar, D. (2013). Effective partnerships: How school nurse and physical education teachers can combat childhood obesity. NASN School Nurse. 2-23. Retrieved from doi:10.1177/1942602X12460891 Fisher, K. (2006). School nurses’ perceptions of self-efficacy in providing diabetes care. The Journal of School Nursing, 22(4), 223-228. Frisco, M. & Weden, M. (2013). Early adult obesity and US women’s lifetime childbearing experiences. Journal of Marriage and Family, 75(4), 920-932. Grossklaus, H. & Marvicsin, D. (2014). Parenting efficacy and its relationship to the prevention of childhood obesity. Pediatric Nursing, 40(2), 69-86.

References-childhood obesity prevention Lepkowska, D. (2014). Looking at the latest data on childhood obesity levels. British Journal of School Nursing, 9(1), 12-14. Must, A., Phillips, S., Tybor, D., Lividini, K., & Hayes, C. (2012). The association between childhood obesity and tooth eruption. Obesity, 20(10), 2070-2074. National Association of School Nurses. (2013). Position statements, issue briefs, resolutions and consensus statements. Retrieved from http://www.nasn.org/PolicyAdvocacy/PositionPapersandReports/NASNPositionStateme ntsFullView/tabId/462/ArticleId/39/Overweight-and-Obesity-in-Youth-in-Schools-The- Role-of-the-School-Nurse-Revised-June-2013 Peate, I. (2014). Addressing the normalization of overweight and obesity. British Journal of School Nursing, 9(3), 115-116. Quelly, S.B. (2014). Childhood obesity prevention: A review of school nurse perceptions and practices. Journal for Specialists in Pediatric Nursing, 19, 198-209. Wells, J.K. & Cole, T.J. (2014). Height, adiposity and hormonal cardiovascular risk markers in childhood: How to partition the associations? International Journal of Obesity, 38(7), 930-935.