Page 98 - MMP-N-NJ CCN 21st Century School Nurse Leadership Book

• Examine the literature and community assessment:

School Community Health Problem/Needs Assessment:
• Grade 4 previous year vision referrals: 12 students/109. 3 referrals returned = 25%
return.
• Grade 6 previous year vision referrals: 13 students/121. 2 referrals returned = 11%
return.
• Inconsistent ability to screen without interruption in busy school nurse office.
• No school-based information on parent/guardian reasons for lack of or delay in
follow-up.
• Inconsistent monitoring of vision referrals sent and returned to school nurse office.
• Need current local eye care professionals and eye specialists list, and contact
information. Engage at least one eye care professional as reference for
recommendations and findings of vision screening for vision failure.
• New Jersey State Health Assessment Data: 10.8% of community is uninsured.
Approximately 19.4% of Hispanics in county are living at or below poverty level (New
Jersey Department of Health, 2015).
• Policy changes required to district manual to ensure evidence-based vision screening.

Steps to Leading Change and Transformation (Kotter, 2007).
See Making Change Happen (p.10):

1. Establish sense of urgency.

• Motivating statement (often communicated to key school administrative decision maker(s)):

Mr./Ms. Administrator,

I know we are both committed to the learning and health of our students. I
am worried about the students who fail and are referred for a more compre-
hensive vision exam. Student learning is influenced by visual acuity, and most
student learning occurs through vision. The American Optometric Association
(2016) reports that 25% of school age children have vision problems. Did you
know that 33% of students with failed vision referrals from schools do not re-
ceive professional exams (Neville et al., 2015)? Studies also report it can take
on average two follow-up phone calls and 18 months after the initial referral
from the school to visit an eye care specialist (Kemper, Helfrich, Talbot, & Pa-
tel, 2012).

Many times, the parent/guardian does not return the referral form. There-
fore, it is unclear whether the child received the services they need. This may
impact the student’s vision – possible permanent vision loss; and impact aca-
demics - behavior problems in the classroom and poor academic performance
(Basch, 2011).

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