NSG 323 Unit 7 school or occupational site analysis example

Asthma and Absence at a 640-Student Middle School: A Site Analysis Framed Around Attendance

Student Name

Department of Nursing, Herzing University

NSG 323: Community and Public Health Nursing

Instructor Name

March 3, 2026

Asthma and Absence at a 640-Student Middle School: A Site Analysis Framed Around Attendance

The Site

The site is a composite public middle school serving 640 students in grades 6 through 8 in an older section of a midsize city. Roughly three in four students are eligible for free or reduced-price school meals. The school's improvement plan names chronic absenteeism, defined as missing 10% or more of enrolled days, as its first priority, because the state reports it on the school's public accountability dashboard. One registered nurse is shared between this school and a nearby elementary school and is on site Monday, Wednesday, and half of Friday; a health aide covers the office on the other days. The nurse reports to the district's health services coordinator, not to the principal, but works in the principal's building and depends on the principal's support for anything that changes how the school runs.

The Population, From the School's Own Records

Records reviewed, with permission of the district, covered August through December 2025: the health office visit log, student health records, and attendance data from the school's information system, all reviewed without student names. Seventy-one students, about 11% of enrollment, have asthma recorded in their health records. Only 29 of the 71, about 41%, have a current asthma action plan signed by a clinician on file. Seventeen have a rescue inhaler at school, either carried by the student or kept in the health office.

The health office recorded 1,920 visits in those five months, of which 212 were for asthma symptoms, made by 38 students. Twenty-six asthma visits ended with the student sent home. Chronic absenteeism was 18% school-wide and 31% among students with asthma, 22 of 71.

Patterns in the Records

Three patterns stand out. First, asthma visits cluster on Mondays and after physical education periods, and the Monday visits fall on days when the health aide, not the nurse, is on site. Second, most students sent home for asthma did not have an inhaler at school; their visits typically ended with a call to a parent, because the aide could not give a medication that was not there. Third, on walking the building, the nurse found that buses idle in the loading lane next to the gymnasium's air intake during morning drop-off and afternoon pickup. That observation does not prove a cause, but it is a plausible trigger worth addressing.

Research has found that students with asthma miss more school than their peers (Moonie et al., 2008). The records here suggest that some of those absences, the send-homes, are avoidable when a rescue inhaler and a plan are available.

Legal Obligations in This Setting

Several obligations apply that would not apply in a clinic. State law allows students to carry and use their own inhalers with written authorization from a clinician and a parent, and the school must permit it. Under Section 504 of the Rehabilitation Act, a student whose asthma substantially limits a major life activity may be entitled to a plan of accommodations, such as access to an inhaler during testing and modified physical education. Health records kept by a school nurse in a public school are usually treated as education records under FERPA, the federal student-records law, rather than under HIPAA, which affects who may see them and how they are shared (U.S. Department of Education & U.S. Department of Health and Human Services, 2019). Finally, when the nurse is not present, any help the aide gives with medication must be delegated and supervised under the state nurse practice act. These obligations are the nurse's strongest tools, because they are requirements the school already accepts.

What the Nurse Can and Cannot Do

The nurse can review records, write individualized health plans, train staff, delegate specific tasks to the aide, contact families and clinicians, and recommend changes. The nurse cannot change the bus schedule, add nursing days, or require teachers to attend training; those decisions belong to the principal, the district transportation office, and the district. The analysis's recommendations are sorted accordingly.

Research on school nursing suggests that nurses' work is linked to outcomes schools care about, including attendance and time spent in class (Lineberry & Ickes, 2015). That link, rather than a clinical argument, is the case the nurse will make to the principal.

Stakeholders and Their Interests

Several people besides the principal shape whether anything changes. Parents decide whether to obtain an action plan and send an inhaler, and many told the health aide last fall that a clinic visit for a form means a missed shift at work. Primary care clinicians sign action plans but rarely receive a request from the school. Physical education teachers see episodes first and have had no asthma training. The attendance clerk records absences but does not know which are health related. The district transportation office controls where buses wait. Each has a reason to help, since every one of them loses time when a student is sent home, and the plan asks each for one specific thing rather than general support.

Recommendations

Within the nurse's authority: contact the families of the 42 students without a current action plan, starting with those who came to the health office for asthma this fall, and send clinicians a one-page request form; train the health aide, under delegation, to follow each action plan and give a student's own inhaler; identify students with frequent asthma absences for 504 evaluation; and give physical education teachers a 20-minute session on recognizing an asthma episode and sending the student with a buddy rather than alone.

Requiring the principal's decision: add the nurse to the school's attendance team, so that health-related absences are identified early rather than after a student is already chronically absent; and ask the district transportation office to move bus idling away from the gymnasium intake and enforce engine shutoff while waiting.

Each recommendation will be presented to the principal in terms of attendance: every student sent home avoidably is a lost school day on the dashboard the principal answers for.

Measures

From January to May, the nurse will track the proportion of students with asthma who have a current action plan, the number of asthma send-homes, and chronic absenteeism among students with asthma, compared with the fall. With 71 students, changes will be small in number and should be reported as counts, not only as percentages.

References

Lineberry, M. J., & Ickes, M. J. (2015). The role and impact of nurses in American elementary schools: A systematic review of the research. The Journal of School Nursing, 31(1), 22-33. https://doi.org/10.1177/1059840514540940

Moonie, S., Sterling, D. A., Figgs, L. W., & Castro, M. (2008). The relationship between school absence, academic performance, and asthma status. Journal of School Health, 78(3), 140-148. https://doi.org/10.1111/j.1746-1561.2007.00276.x

U.S. Department of Education & U.S. Department of Health and Human Services. (2019). Joint guidance on the application of the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to student health records (2019 update).