1. Today, as a result of
widespread
availability of digital
devices and shifting
societal attitudes
toward
entertainment, many
children prioritize watching television or playing video games
as opposed to getting enough physical exercise. This trend is
exasperated by a decline in healthy eating habits. As a
result, it is increasingly important for school nurses to be a
visible presence in the school community and develop and
implement strategies to improve the health and wellness of
children.
School nurses play a vital role in educating students while at
school. The National Association of School Nurses (NASN)
defines school nursing as a:
“specialized practice of professional nursing that
advances the well-being, academic success, and life-
long achievement of students and facilitates positive
student responses to normal development”
(NASN, 2010)
Health & Wellness
Role of the School Nurse
Health & Wellness Methods
Jordan Kessler- Research/Issue Brief UC DENVER NURS 6973
 Promote health and
safety, including a healthy
environment
 Intervene and assess
existing and potential
health problems
 Provide case management
services to students and
parents
 Build student and family
capacity for adaptation,
self-management, self-
advocacy and learning
School Nurse
Responsibilities
Research brief: There is
evidence of what types of
health and wellness work
best.
Issue brief: There is
a lack of evidence
in the Chinese
culture; therefore,
we need to
replicate the
research.

2. 2
Health & Wellness Deficiencies in Schools
Compared to their
parents’ generation, a
greater proportion of
students develop
health problems
including obesity,
diabetes, and other
chronic illnesses,
according to recent
studies. In the U.S.,
school nurses regularly
implement programs to
educate students and
parents on the
importance of wellness
resulting in decreased
health risks, positive
lifestyle changes, and
improvements to
overall health.
Research on Health & Wellness Methods
 Lack of health & wellness awareness among leadership, staff, students and parents
 Limited access to healthy food choices and improving nutritional quality
 Physical activity and physical education decline as children advance
through school grades, more focus on core classes
 Lack of policy implementation, resources, monitoring and evaluation
 Decrease interest in health & wellness
 Decrease in parental involvement; Both parents working
 Lack strong administrative and system support
Troy University School of Nursing identified that in addition to an RN, primary
schools should employ a dedicated school wellness nurse to implement and
sustain the 2010 Health Hunger-Free Kids Act policy and guidelines. Data
analysis indicates positive student outcomes as a result of increased
participation in moderate to vigorous physical activity and improved dietary
behaviors (Avery et al., 2013).
A 6-week randomized study included 45 minutes of weekly physical activity and
nutrition education classes for parents and children instructed by the school
nurse. In addition, the nurse led interventions such as: implementation of
school wellness policies and procedures such as dietary changes at school,
creating wellness activities, staff development teachings and sent bimonthly
newsletters. Data collected at the end of the 6-week program showed
significant improvement results for both boys and girls (Wright et al., 2013).
WellBAMA, is a collaborative model developed by medical professionals to
encourage employees to make and sustain healthy decisions (Carter et al.,
2013). The program provides innovative opportunities for employees such as on
site health screenings, healthy advising sessions, and assistance in monitoring
individual health goals. Nursing student’s benefit from this program by learning
how to apply clinical skills, collaborative skills, and communication skills.
Studies show that one clinical rotation in WellBAMA can improve NCLEX scores
by 23%

3. 3
Research shows that school nurses
play an important role in
educating students and parents on
health and wellness. Currently, as
a result of a lack of existing
English language research on
student health and wellness
implementation in the Chinese
Benefits of Health &
Wellness Programs
 Onsite health screenings
 Health advising sessions with nutrition education
 Individual health monitoring solutions
 Increase health and physical education in the school curriculum
 Exercise programs and promotion
 Health & wellness training for staff
 Creation of health & wellness tool kits, newsletters, and an informational
blog
 Health & wellness employee program
Implementation ideas & further research needed
SchoolnursesnotonlysupplyBand-Aids,butaccordingtotheirjobdescription,theschoolnurseiscalledto
makevisitstothechild’shometohelpcoordinatecarewithfamiliesandeducateparentsandchildrentotake
initiativeinbetteringtheirhealth(Moneyheffer2012).
Healthy
lifestyle
Incr ease
physical
acitivity &
education
Impr ove
healthy food
choices &
eating
habits
Elevate self
esteem and
over all
satisfaction
Raise
student
mor ale,
impr ove
gr ades
Advance
healthy
initatives at
school &
home
Health & wellness
methods within Chinese
Culture
culture, this issue brief attempts
to target two audiences for
successful implementation.
In the Chinese cultural context,
children are pressured to do well
in school reducing the time spent
participating in sports and
physical activity. Parents play a
key role in organizing a student’s
schedule and deciding
extracurricular activities. School
nurses must persuade parents to
understand the benefits of
exercise to the child’s academic
success.
The second audience, children,
suffer from extreme parental
pressure to excel academically.
The nurse must persuade students
that physical activity will manage
and reduce stress and help them
excel in their challenging
academic schedules.
Project implementation will be
needed to test the best strategies
for improving child health in the
school context.

4. 4
“Aliquam
ullamcorper
nonummy metus.
Duis dapibus lectus
vitae odio.”
- Lorem Ipsum
Purpose
In the U.S., school nurses regularly implement programs to educate students and parents on the
importance of wellness resulting in decreased health risks, positive lifestyle changes, and improvements to
overall health. As a school nurse in China, wellness programs in international schools are under developed
and have the potential of greatly expanding existing programs to better serve and benefit their student
communities. The purpose of the annotated bibliography is to conduct an integrative literature review on
methods to educate parents and children on wellness within the Chinese culture to assist with writing a
research or issue brief.
Research
Research began at the Anschutz Health Sciences Library with a key word search: methods, wellness
programs, education, school nurse responsibilities, school nurse wellness programs, interventions by school
nurses, implementations by school nurses, innovations in wellness, China, and Chinese culture. Fifteen
articles on the importance of school nurses and their responsibilities were discovered; however, identifying
detailed nursing methodologies in modern educational systems proved elusive. No specific articles were
found based in China. As a result, key words were expanded to include emphasis outside of school nursing:
web based family education, innovate ideas in wellness and education for children, and community health
nursing. Six research articles were found and described how school nurses lead health education and
wellness in schools. The search parameter was further narrowed to three articles focused on specific data for
schools that conducted research on successful health education programs implemented by a school nurse. In
addition, other relevant research included articles and blogs on Google, Department of Health Services,
American Nurses Association (NAN), and National Association of School Nurses (NASN). These sources
augmented academic research with additional information on school nursing methods such as information on
educational school nurse programs, specific toolkits used in schools for wellness, and current innovative
school wellness practices. One columnist article was found on the importance of making the Chinese
community health and wellness and priority from China.org.cn. Furthermore, limited amount of research
was found on health and wellness in the Chinese culture.
No connection between authors, medical professionals, and individuals interested in health and

5. 5
No connection between authors, medical professionals, and individuals interested in health and
wellness for adolescent children was found. No specific research study found linked to other researcher
articles. Most article authors possess a medical background or are medical professionals. In addition, non-
scientific journalistic research offered limited cited source material for additional follow-up.
Twelve significant articles were chosen for the annotated bibliography to summarize my integrative
literature review. Topics chosen include: school wellness nurse demands, nurse coordinated school obesity
program implementation, a nurse led health program to educate students and staff, importance of school
nurses, why school nurses are needed to decrease obesity rates in school, resourceful websites for school
nursing, and learning about health and wellness in nursing school can improve overall community health.
Two of the articles chosen on China include one columnist review on health and wellness and one study on
adolescent children in China.
Final Statement
Research shows that school nurses play an important role in educating students and parents on health
and wellness. From implementing health and wellness programs to incorporating the school nurse as the
main health educator, evidence indicates school nurses advocate on behalf of the children and improve
overall school health. However, there seems to be a lack of existing English language research on health and
wellness in the Chinese culture. Therefore, a combined research and issue brief is suitable for the
environmental topic chosen. The research brief: there is evidence of what types of education and wellness
work best. Issue brief: there is a lack of evidence in the Chinese culture; therefore, we need to replicate the
research.
Berkowitz & Borchard (2009) start the article by explaining the background of childhood obesity and
contributing factors of why children in the U.S. are overweight. To prevent childhood obesity,
Berkowitz & Borchard explain how nurses develop certain skills such as advocacy, collaborative
leadership and social marketing to prevent childhood obesity. These skills ensure nurses are able to
promote strategies to prevent childhood obesity (Berkowitz & Borchard, 2009). As a result, these
skills equip nurses with the tools to increase influence in the development of policies and programs.
The article offers helpful information on childhood obesity with specific facts, including: obesity risk
factors, intervention and prevention information, and nurse treatment strategies.
Carter, M., Kelly, R., Montgomery,M., Cheshire,M. (2013). An innovate approach to health promotion
experiences in community health nursing: a university collaborative partnership. Journal of Nursing
Education, 52(2), 108-111. doi: 10.3928/01484834-20130121-04

6. 6
Annotated Bibliography
Avery, G., Johnson, T., Cousins, M., Hamilton, B. (2013). The school wellness nurse: a model for bridging
gaps in school wellness programs. Pediatric Nursing Continuing Nursing Education (CNE), 39(1),
13-17. Retrieved from https://www.pediatricnursing.net
/ce/2015/article390113017.pdf
School is an environment where influencing health and wellness can help promote interventions to
reduce obesity rates in students. Health and wellness not only benefit obese students, but all students.
To help decrease obesity rates, U.S. schools have mandated school wellness programs and
interventions; however implementation is difficult because of the many gaps found across programs.
A predictive study conducted by Troy University School of Nursing, identified that schools with
RN’s need a dedicated school wellness nurse to implement and sustain the 2010 Health Hunger-Free
Kids Act policy and guidelines. One of the gaps mentioned states, because of lack of resources in
low-income communities; the school nurse is faced with increased workload and unable to focus on
other important policies and guidelines required. This article is valuable to my research because the
project included three goals and assessed the program over a three-year period. In addition, the article
provided projected data analysis, which indicated positive student outcomes as a result of increased
participation in moderate to vigorous physical activity and improved dietary behaviors (Avery et al.,
2013). Overall, school wellness nurses can benefit students by bridging the gap in wellness policies
and sustaining health promotion.
Berkowitz,B., Borchard, M. (2009). Advocating for the prevention of childhood obesity: a call to action for
nursing. The Online Journal of Issues in Nursing. 14(1), 1-9. Retrieved from
http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofCont
ents/Vol142009/No1Jan09/Prevention-of-Childhood-Obesity_1.aspx
Berkowitz & Borchard (2009) start the article by explaining the background of childhood obesity and
contributing factors of why children in the U.S. are overweight. To prevent childhood obesity,
Berkowitz & Borchard explain how nurses develop certain skills such as advocacy, collaborative
leadership and social marketing to prevent childhood obesity. These skills ensure nurses are able to
promote strategies to prevent childhood obesity (Berkowitz & Borchard, 2009). As a result, these
skills equip nurses with the tools to increase influence in the development of policies and programs.
The article offers helpful information on childhood obesity with specific facts, including: obesity risk
factors, intervention and prevention information, and nurse treatment strategies.
Carter, M., Kelly, R., Montgomery,M., Cheshire,M. (2013). An innovate approach to health promotion
experiences in community health nursing: a university collaborative partnership. Journal of Nursing
Education, 52(2), 108-111. doi: 10.3928/01484834-20130121-04
As chronic illness become prevalent in society, it is important for nurses to advocate health
promotion and wellness. Health promotion is learned in nursing school and provides students with
specific clinical experience to develop essential nursing competencies. In addition, a core aspect of
the Affordable Care Act is ensuring health promotion is central to healthcare reform. As stated in the
article, most universities benefit from work site health promotion programs that improve employee
health, especially programs conducted by nursing students (Carter et al., 2013). One of the programs
mentioned in the article, WellBAMA, is a collaborative model developed by medical professionals to
encourage employees to make and sustain healthy behaviors (Carter et al., 2013). The program offers
employees innovative opportunities such as on site health screenings, health advising sessions, and
individual health monitoring solutions. In addition, nursing student’s benefit from this program by
learning how to apply clinical skills, collaborative skills, and communication skills. Furthermore,

7. 7
studies show that one clinical rotation in WellBAMA can improve NCLEX scores by 23% (Carter et
al., 2013). Health promotion programs provide a special opportunity for nursing students to partner
with the community and deliver clinical expertise to patients who are in need of wellness education.
This article is important to the research, as health promotion applied in the school context is critical
to healthy child development.
Clark, E. (2016). Making community health and wellness a priority. China.org.cn. Retrieved from
http://www.china.org.cn/opinion/2016-02/03/content_37725146.htm
Clark starts the article by highlighting the importance of a healthy environment and the resulting
health care cost reductions and citizen health improvements for communities. Clark shares
methodologies to improve overall community health and wellness, including: comprehensive health
insurance systems, increasing health and physical education in schools, exercise promotion, and road
infrastructure improvement. This article is valuable to the literature review because of the focus on
China’s unique health needs and the cultural elements required to succeed in implementation.
Currie, D. (2013) Report calls for nurse in every school, focus on student wellness. Nation’s Health, 43(3).
Recent studies show a link between an achievement gap and health disparities in underserved
populations. Education and health are closely linked and can improve overall wellness. A recent
report notes the important of a nurse stationed in every school to strengthen the student’s health and
wellness (Currie, 2013). With the implementation of a school nurse, students are more likely to
attend to wellness activities in school such as monitoring of unhealthy air, improve physical activities
for students, and monitor access to food and fresh water. Other recommendations stated in the article
include expanding the Office of Safe and Healthy Students and support the development of training
for teachers and staff to improve campus health and wellness. Because health and education are
strongly linked, it is important for schools to swift their approach towards wellness during the school
day. This article is valuable to the literature review as it provides recommendations of wellness
implementations and how including a school nurse on campus can improve overall health.
Moneyheffer, K. (2012). The changing shape of america’s youth: combating childhood obesity using the
school nurse. Student Pulse, 4(3), 2-21. Retrieved by http://www.studentpulse.com/articles/626/2/the-
changing-shape-of-americas-youth-combating-childhood-obesity-using-the-school-nurse
School nurses play an important role in identifying children who are at risk for developing health
problems. School nurses not only supply Band-Aids, but according to their job description, the school
nurse is called to make visits to the child’s home to help coordinate care with families and educate
parents and children to take initiative in bettering their health (Moneyheffer, 2012). At most schools,
children see the school nurse at a regular interval and are in constant contact with teachers and
parents on school health related issues. School nurses answer parent questions and assist teachers and
staff with educational tools and resources. School nurses implement in-school childhood obesity
reduction programs and equip children with the tools necessary to successfully adapt their lifestyles
to these changes (Moneyheffer, 2012). The information stated in this article is valuable to this project
because it explains the potential of the school nurse to instigate lifestyle changes in unhealthy
students.
NASN - National association of school nurses - NASN.org . (n.d.). NASN - National Association of School
Nurses - NASN.org . Retrieved from http://www.nasn.org
This website includes an extensive array of resources for school nurses. These include health and
wellness toolkits, health policies, health blogs, articles pertaining to health and wellness. The
information from this website is pertinent to the project as it references a wide variety of health
resources for child health related topics.

8. 8
information from this website is pertinent to the project as it references a wide variety of health
resources for child health related topics.
NASN School Nurse (2010). Expand your wellness efforts with he healthy schools program. Sage Journals.
25(1), 34-36. doi: 10.1177/1942602X09353181
In 2005, obesity rates were doubling, so the American Heart Association and William J. Clinton
Foundation united and formed Alliance for a healthier generation. The goal was to reduce the obesity
rates and empower children to make healthy lifestyle choices at home, school, and in the community.
One of the beliefs of Alliance was the power of a school nurse to encourage a healthy environment to
children around the world. Alliance created The Healthy Schools Program that included many
benefits to improving health and wellness in school. This article was valuable to the research because
it mentioned important tools and research for school nurses to use for health promotion such as: free
support and tools, including tool kits offering best practices for physical activity and healthier eating.
In addition, this program was developed to help schools improve access to healthier foods; increase
physical activity opportunities before, during, and after school; enhance nutrition education; and
establish school employee wellness programs (NASN School Nurse, 2010). Healthy Schools Program
is active in the United States and has reached over 6,000 schools. Black Mill Elementary School is an
example of a successful implementation of The Healthy Schools Program. This program affected the
food service staff, teachers, students, and parents by providing healthier school meal options,
improved physical and health education, increased physical activity opportunities, and wellness
teaching initiatives. Thus, a school nurse can be a student advocate and create opportunities to
improve the standards of health and wellness in the school setting.
Nestle News (2010). The nestle health kids program widens its reach to schoolchildren in the Chinese
province of Yunnan. Nestle China. Retrieved by http://www.nestle.com/media/
newsandfeatures/nestle-healthy-kids-programme-extends-in-china
The Nestle Healthy Kids Program began in 2010 and aims to improve overall health and wellness for
children ages 6-12 years old. The program promotes nutrition education, a balanced diet, increased
physical activity and an overall healthy lifestyle (Nestle, 2010). This program is valuable to the
project as it pertains specifically to childhood obesity and increasing overall wellness for children
living in China. Though the program does not provide implementation results, the cultural and
demographic focus makes it relevant to the project.
Tudor, C., Ainsworth, B., Adair, L., Popkin, B. (2003). Physical activity and inactivity in chinese school
ages youth: the china health and nutrition survey. International Journal of Obesity, 27, 1093-1099.
doi: 10.1038/sj.ijo.0802377
Obesity rates in China are lower than in most countries, however, as a result of recent health and
nutrition changes, obesity in the society is becoming a problem. The purpose of the study is to
research children’s physical activity and inactivity in China. A random cluster longitudinal survey
method was used to collect data for children aged 6-18 years old. The data indicates a total of 5% of
males and 4% females are classified as overweight. Furthermore, 84% of youth participate in
physical activity and 72% engage in study related activities after school (Tudor et al., 2003). Chinese
culture emphasizes study as opposed to physical exercise resulting in heightened inactivity among
students. The project will address this cultural norm and evaluate effective methods of overcoming
societal resistance to health and wellness.
Wright, K., Giger, J., Norris, K., Suro, Z. (2013). Impact of a nurse-directed, coordinated school health
program to enhance physical activity behaviors and reduce body mass index among minority
children: a parallel-group, randomized control trial. International Journal of Nursing Studies. 50(60),
727-737. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654538/

9. 9
children: a parallel-group, randomized control trial. International Journal of Nursing Studies. 50(60), 727-
737. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654538/
Students are recommended to have at least 60 minutes of physical activity a day. In underserved
populations, many adolescents are not meeting these requirements. As childhood obesity becomes
increasingly prevalent, the literature shows that school based obesity prevention programs are most
effective. However, because the program can be costly and time consuming to implement, this study
researches the impact of a nurse coordinated school based obesity prevention program. A 6-week
randomized study conducted by health care professionals included two interventions: weekly 45
minutes of physical activity and nutrition education classes for parents and children instructed by the
school nurse. In addition, the nurse was in charge of environmental interventions such as:
implementation of school wellness policies and procedures such as dietary changes at school,
creating wellness activities for students and staff, staff development teachings and bimonthly
newsletters sent to parents. Data collected at the end of the 6-week program showed significant
results for both boys and girls including a reduction in television viewing for boys, increased daily
physical activity and physical education class attendance for girls, and a decrease in body mass index
from baseline to the 12 month follow up (Wright et al., 2013). Thus, school nurses are highly
valuable in implementing and sustaining health and wellness by decreasing disparities in student
activity and television viewing in the underserved population. This study is valuable to the literature
review by providing me a successful wellness method researched, analyzed, and implemented in the
U.S.
U.S. Department of Health and Human Services. (2011). Prevention and wellness. Retrieved from
http://www.healthcare.gov/prevention/index.html
This website provides information on preventive health services for women, men, and children. The
information is beneficial to the literature review as it provides health and wellness assessments for
children and offers chronic health prevention information. In addition, the website includes shareable
tools, health news, and informs patients about specific health services.