Standard 5

The Socio-Cultural Context of School Nursing

The program provides candidates with opportunities to further develop their understanding of the sociocultural context in which school nurses work.  As part of these opportunities, candidates experience the range of diversity represented within the local community including culture, ethnicity, language, age, gender, gender identity, students with special needs, socioeconomic status and value systems.  The program assists candidates to formulate strategies for identifying and appropriately addressing social and cultural community issues that affect school health and students’ abilities to learn. The program assists candidates to adapt their approach in order to meet the needs of English learner students and their families.

Criterion 1: The program provides candidates with the opportunities to further develop their understanding of the socio-cultural context in which school nurses work in the school setting.

Candidates learn that understanding a child’s development and health issues must include understanding of the family and socio-cultural environment. Vygotsky (1934/1986) argued that a child’s development cannot be understood by a study of the individual alone, but we must also examine the external social world in which that individual life has developed. He described learning as being embedded within social events and occurring as a child interacts with people, objects, and events in the environment. For this reason, it is imperative that candidates have a good understanding for the socio-cultural environment in which the school population the candidate serves interacts with in order to serve them more meaningfully. Community health coursework as a prerequisite is required for candidates entering the program: The majority of candidates entering the program having completed a BSN program that includes community health coursework leading to a PHN. While field experience may have taken place in another area of the state/country in some cases, and may not always be relevant to the school population the candidate plans to serve, the understanding for community issues as a whole is invaluable to school nursing practice. Candidates entering the program having completed a bachelor’s degree in another field are required to take community health coursework at the university level, with field experience taking place in their planned area of school nursing practice. Emphasis is placed on the need for candidates to know and understand the socio-cultural, socio-economic, health issues within the community and insight into relevant community resources (a PHN is not required). California State University, Fresno offers community health coursework through the RN to BSN program, NURS 141, Concepts in Community Health (3U), and NURS 141L, Practicum in Community Health Nursing (3U).

In NURS 184, Introduction to School Nursing (seminar) candidates are made aware of socio-cultural issues in the community and in the school population, examples are seen in the following weeks questions: Coordinated school health programs that meet the needs of the school population (Wk 2); Role of the school nurse in understanding for cultural competence, issues associated with children of migrant and refugee families (Wk 7); issues related to poverty and homelessness, children of dysfunctional families, transcultural differences (Wk 11); serving students in special education (Wk 13-15); meeting the needs of foster children in the system and the role of the school nurse (Wk 14). Candidates in NURS 184 are asked to choose one of two assignments that relates specifically to understanding cultural differences: to read a book by Ann Fadiman (1997) The Spirit Catches You and You Fall (likely the best account of understanding breakdown of cultural difference ever written), or candidates may choose to do a cultural interview on a family new to the United States that is other than their own culture. Either assignment gives students excellent insight into issue related to cultural difference. Candidates use cultural theories in written assignments and in practice, i.e., Leininger’s Transcultural Nursing Model. In NURS 185, School Nurse Seminar, socio-cultural issues are covered in weekly questions in the following areas: Special education population in the secondary population (Wk 1); substance abuse issues in the adolescent population (Wk 6); Coordinated school health programs, adolescent and family involvement (Wk 2); teen pregnancy trends among the Hispanic populations or another ethnic group in your area (Wk 8); mental health issues that tend to affect specific populations (Wk 9 and 10); gang activity and violence, motivation to join gangs, hate motivated behavior, racial and ethnic issues and the role of the school nurse (Wk 11). In NURS 187, School Nurse Practicum II, (secondary), candidates are asked to answer a journal question that involves finding out the percentage of the student population that falls into specific ethnic groups and to link specific health issues and health problems found to be associated with each of these groups, comparing their findings with the general population. Candidates are also required to spend 8 to 10 hours each semester out in the community becoming acquainted with community resources and visiting community agencies and programs to gain insight into community health issues and how health needs are being met.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E18, E19 and S13, S24, S26, S27, S29 for candidate competency in understanding of the socio-cultural context in which school nurses work.

Criterion 2: As part of these opportunities, candidates experience the range of diversity represented within the local community including culture, ethnicity, language, age, gender, gender identity, students with special needs, socioeconomic status and value systems:

In didactic courses (NURS 184 and NURS 185) candidates learn about socio-cultural issues, socioeconomic issues facing families in the community, as well as issues relevant to students with special needs, gender issues, etc., the knowledge of which candidates bring with them into their practicum experiences.  Candidates develop a keener awareness and sensitivity for cultural and ethnic difference which candidates can use in meeting the needs of children and families. Candidates gain insight into socioeconomic issues that may impact a child’s ability to stay focused and learn, i.e., hunger, i.e. children who  may be kept out of school to work in the fields to support the family; candidates learn about free or reduced school nutrition programs and qualifying factors., issues related to poverty, homelessness, concerns for migrant and refugee families and children; and about caring for students with special needs, issues related to gender confusion and identity. Candidates in the program are reminded that the school nurse must reach outside of the building and become involved in the community in order to understand the socio-cultural, socioeconomic, and health related issues that affect the children they serve in their schools. As was previously mentioned, candidates coming into the program are required to take community health coursework as a prerequisite to entering the program which has given them an initial awareness of community public health issues.

Exposure to diversity represented in the community in practicum courses (NURS 186 and NURS 187). Candidates are required to take two (3U) practicum courses, a total of 270 hours. (Note: Fifteen hours each course is set aside for candidate participation in class discussion and conferences with clinical instructors.) In each practicum course, under the supervision of a qualified school nurse preceptor, candidates spend 120 hours interacting with students at school sites, families, community agencies and programs. Candidates who are employed as school nurses while in the program are given 40 hours credit towards their practicum experience since they are already actively engaged in working with students and families at their own school sites. In practicum courses, candidates have the opportunity to assist students in schools that reflect the surrounding community of which they are a part.  Candidates interact with students of all ages from preschool to grade twelve, and young adults returning to school in continuing education programs. Candidates counsel, teach, and meet the healthcare needs of students of both genders, gain insight into gender identity issues, students in special education programs with a variety of learning disabilities and health needs. Candidates also grow to understand that different ethnic, cultural, and socioeconomic groups have values that may differ from their own and that the school population is a reflection of the surrounding community. Candidates are continually exposed to the diversity each day that they interaction with students, families, and staff within the school setting. As previously mentioned, candidates also spend 8 to 10 hours in each practicum out in the community becoming familiar with services and programs. Finally, candidates in NURS 186, School Nurse Practicum I, are expected to complete a case study on a school age child of a culture other than their own. In doing the case study, candidates are expected to make a home visit to gain first-hand insight into a family situation and becoming acquainted with practices, beliefs and values.

In practicum courses, candidates recognize indicators of the socioeconomic condition of the general community that are reflected in the school population. For example, the percentage of students in school who qualify for the free or reduced breakfast and lunch programs, the percentage of students without health insurance coverage, those in need of dental care, children whose parents can’t afford glasses, parents who come to the school nurse requesting sources of free food, shelter, and clothing, and the percentage of students in school who are English as a second language learners and whose parents need help to overcome language barriers to access community services. Candidates soon become aware that the role of the school nurse extends beyond meeting the immediate healthcare needs of student, to becoming a resource person who must be knowledgeable about community resources to meet the health and basic survival needs of students and their families. The fact that candidates are required to have had community health coursework and must spend at 8-10 hours in each practicum course out in the community becoming familiar with resources gives the candidate insight into community issues.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E19 and S13, S24, S26, S27, S29 for candidate experience as it relates to understanding the range of diversity represented within the local community.

See Sec. 3 (p. 407): NURS 186 and NURS 187 Preceptor Syllabus, Evaluation of Student Professional Dispositions:   Disposition 4, “Candidate demonstrates the dispositional tendency to value diversity – cultural, linguistic, cognitive, and physiological.” (This disposition is critical to differentiating instruction and creating psychologically and physically safe helping/learning environments.

Criterion 3: The program assists candidates to formulate strategies for identifying and appropriately addressing social and cultural community issues that affect school health and students’ abilities to learn:

Candidates learn that in order for children and adolescent put their full attention to optimal learning, students must see the school environment a harmonious place where there is understanding and acceptance for those from the various groups in the school community. This means that school staff, including the school nurse, must work to make that happen. In core school nurse courses, candidates learn that, in order to work effectively with children and families of diverse cultures, the candidates understand the complex social, political, and economic forces that shape the lives of clients, so that the candidate can effectively promote health and well being within a school community. In NURS 184, Introduction to School Nursing, candidates learn about models and frameworks of cultural competency, i.e., Leininger (Wk 11). An assignment in this course, that further helps candidates understand the importance of working effectively with those of another culture, is a required book report on cultural differences or an arranged interview with a family of a culture other than the candidates own. Candidates learn demonstrate understanding that racial and ethnic groups may view health care and healthcare professionals from a perspective based on their previous experience and knowledge. They come to understand these different views and recognize that healthcare must be provided appropriately and respectfully. Candidates also come to recognize that they must examine their own personal cultural beliefs and identify potential prejudices or stereotypical triggers that may affect their ability to work effectively with a particular group or client. Candidates also learn to understand that cultural diversity is not only about racial and ethnic groups, it can be a particular group with a pattern of beliefs, values, and actions that can cause one to view them as a cultural group.  In practicum courses (NURS 186 and NURS 187), candidates have the opportunity to put into practice what they have learned about relating effectively with various social and cultural groups and individual students. Under the supervision of a qualified school nurse preceptor, candidates partner with other members of the educational team in working to creating a harmonious and friendly atmosphere within the school community, i.e., participating in anti-bullying efforts, participating in campus activities that help the school community understand and appreciate the uniqueness of other cultures, demonstrating tolerance in school nursing practice, taking the time to learn about a particular culture or ethnic group before addressing a health need, working to break down communication barriers through being sure that written communications to families go home in their own language, use of interpreters in the case of limited or non-English speaking students and families; and advocating for families as needed.

See Sec. 3 (p. 396 and p. 401) NURS 186 and NURS 187 Preceptor Syllabus checklists – E18 and S13, S24, S26, S27, S29 for candidate ability to formulate strategies for identifying and appropriately addressing social and cultural community issues that affect school health and students’ ability to learn.

Criterion 4: The program assists candidates to adapt their approach in order to meet the needs of English learner students and their families:

In NURS 184, Introduction to School Nursing Practice, candidates learn about the need for cultural sensitivity, referring to an attitude towards a culture or ethnic background different from one’s own, and cultural competence, the process of understanding and respecting the cultural values and practices of clients. An assignment choice in NURS 184, to read and report on a book by Anne Fadiman (1996) The Spirit Catches You and You Fall Down, or to report on an arranged interview with a family member from another culture other than the candidate’s own. Either of these assignments prepares candidates to understand the importance of cultural sensitivity and cultural competence. Before meeting with a client or family from a cultural or ethnic group other than the candidate’s own, candidates are expected to prepare for that meeting through reviewing literature relevant to that particular client’s culture, i.e. customs, beliefs, habits, etc. Candidates make arrangements with an appropriate interpreter who will accompany the candidate on a home visit, or be present during an office visit, to break down the communication barriers and bring understanding to both parties. Candidates demonstrate cultural competence throughout their interaction with a client or group from another culture, i.e., through an awareness of one’s own values and attitudes so as not to influence one’s attitudes toward others; through demonstrating awareness of the client’s culture, health-related needs, and understanding of health and illness; and through demonstrating the ability to adapt care to be congruent with the client’s culture. Candidates also learn the importance of being sure that information sent home to parents can be understood, i.e., written notices to parents in their own language, simplifying/adapting lessons for English learners and/or enlisting the help of the classroom teacher in interpreting and explaining, and posting notices in the health office in other languages, etc.

See Sec. 3 (p. 396 and p. 401): NURS 186 and NURS 187 Preceptor Syllabus checklists – E18 S24, S27 for candidate ability to adapt their approach in order to meet the needs of English learner students and their families.

See Sec. 3 (p. 407) NURS 186 and NURS 187 Preceptor Syllabus checklist, Evaluation of Student Professional Dispositions.  Disposition 4, “Candidate demonstrates the dispositional tendency to value diversity – cultural, linguistic, cognitive, and physiological.” (This disposition is critical to differentiating instruction and creating psychologically and physically safe helping/learning environments.)

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