The Journal of School Nursing2025, Vol. 41(4) 457–469© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/10598405231195573journals.sagepub.com/home/jsn
Abstract
The scope of the school nursing practice tool (SSNPT) is needed to apply and explore the gap between what school nurses perceive as important and actual practices. This study adapted and validated the Korean version of SSNPT (K-SSNPT) among 360 Korean school nurses in January 2022. The reliable and valid K-SSNPT can inform school nurses’ workforce policies by capturing the current scope of school nursing practice and setting priorities for improving school health in South Korea.
Keywordsinstrument adaptation, school nursing practice, scope of practice, psychometric testing, school nurses
School health services are essential in public health as a viable strategy to address the health needs of adolescents and enhance health prevention and promotion. Especially during the recent global COVID-19 pandemic, school health services have become crucial for students’ right to health and education. School nursing is a specialized practice of nursing that protects and improves students’ health, development, and successful academic performance (NASN & ANA, 2017). School nursing has evolved dramatically over the past 20 years (Davis et al., 2021), and school nurse-led interventions have been shown to improve students’ health and academic outcomes (Best et al., 2018; Maughan et al., 2018; Yoder, 2020).
However, school nurses have faced a variety of challenges. The health issues in schools that fall under the responsibility of school nurses are becoming more complicated and diverse, such as violence, bullying, and drug and substance abuse, and there are difficulties in accurately assessing and managing the complex health needs of students (NASN & ANA, 2017). Additionally, the demand for school nursing services has been constantly increasing. According to a Korean Educational Statistics Service data analysis, the average number of visits to the school nurse’s office in South Korea is increasing from 3,689 cases in 2017 to 3,789 in 2018 and 3,967 in 2019 (Korean Education Statistics Service, 2020). As the number of students with chronic illnesses who attend school grows due to advances in medical technology, the responsibility and workloads of school nurses to maintain and control the safety of students with chronic illnesses at school has also been increasing (Maughan et al., 2018; Leroy et al., 2017; Yoon, 2021).
The scope of school nursing practice (SSNP) could be essential in guiding complex and expanding school nursing practices (Davis et al., 2021; White et al., 2021). The SSNP clarified the complex and dynamic school nursing by explaining school nursing practice in detail. It also presents competencies for providing optimal services based on the scope and rationale of school nursing practice. Notably, the scope of practice contributed to mitigating issues arising from the wide variations and gaps in field experiences of school nurses and most school nurses being the sole healthcare provider in an educational setting (Davis et al., 2021; National Association of School Nurses, 2017; Willgerodt et al., 2018).
American Nurses Association (ANA) and National School Nurses Association (NSNA) periodically presented the scope and standards of practice regarding school nursing (National Association of School Nurses, 2017). They also published the framework for 21st-century school nursing practice (the Framework) as a principle for providing quality services based on the expanded scope and rationale of school nursing practice (National Association of School Nurses, 2016). The Framework consists of five principles: care coordination, leadership, quality improvement (QI), community/public health, and standards of practice. The “Standards of Practice” principle is crucial for evidencebased and clinically competent quality care that surrounds other principles (National Association of School Nurses, 2016).
Based on the principles of the Framework, White et al. (2021) developed the SSNPT. Measuring school nursing practice leads to optimal school nursing practice by understanding school nurses’ level of competency and identifying gaps between practices and desired principles (White et al., 2021; Yoon, 2021). Additionally, investigating the relationship between the scope of school nursing practice and the health outcomes of students could identify critical areas of school nursing practice that can contribute to improving the health and education of the school community (White et al., 2021).
However, there has yet to be a valid tool to measure the school nursing practices in South Korea, and no instruments have been developed to measure it. A study that identified the competence of school nurses in South Korea (Bae et al., 2012) does not reflect the recent changes in school nursing practice and does not have a measurement scale. A previous study developed a scale to measure school nurses’ emergency nursing care competency limited to emergency school nursing practices (Yoon, 2021). Therefore, this study aimed to develop a Korean version of SSNPT (K-SSNPT) and cross-culturally adapt and validate the K-SSNPT for measuring the scope of nursing practice conducted by school nurses in South Korea.
A cross-sectional and methodological research design was used to test the reliability and validity of the K-SSNPT. Convenience sampling was used for participant recruitment. Data were collected from January to February 2022 via a link within the study announcement. The announcement was posted on the Korean School Nurses’ Association website. The eligible participants were current school nurses employed at elementary, middle, high, and special schools. School nurses who were on leave during the survey were excluded. Participants were recruited and classified into five groups according to their experience in school nursing: (a) novice (less than 1 year), (b) advanced beginner (1 year to less than 3 years), (c) competent (3 years to less than 6 years), (d) proficient 1 (6 years to less than 16 years), and (5) proficient 2 (16 years or longer) (Yoon, 2021).
The appropriate sample size for confirmatory factor analysis (CFA) was 300 (Koyuncu & Kilic, 2019), and the minimum sample size for the current study was set to 330, considering a 10% drop-out rate. In addition, for the evaluation of contrasted group validation, the sample size of each group of school nursing experience was set to over 60 individuals (medium effect size = 0.25, significance level = 0.05, power = 0.95, number of groups = 5, covariates = 20). As a result, a total of 370 school nurses were enrolled, and the final 360 respondents were analyzed after excluding 10 (2.7%) participants with missing data.
The general information questionnaire. In order to evaluate contrasted group validation of the general characteristics, variables were selected to control confounding variables in the comparative analysis of the scope of school nursing practice according to each school nurses’ experience group. The demographic characteristics presented in previous study (Rizany et al., 2018) were measured in the present study: general characteristics (gender, age, marital status, religion, subjective health status, and perceived stress level), education level, work experience (school nurse’s experience, hospital nurse’s experience, and employment status), and type of nursing environment (level of school, school location, type of school, total number of students, number of classes, number of visitors to the nurse’s office, and overall school satisfaction).
Scope of school nursing practice tool. The SSNPT is a selfreported questionnaire that measures the scope of school nursing practice using a 6-point Likert scale. The items of SSNPT were developed based on the 18 competencies on the scope and standards of practice created by the ANA and five principles of the Framework presented by the National Association of School Nurses (NASN; White et al., 2021). The SSNPT consists of 31 items across four dimensions: (a) using the nursing process (10 items), (b) applying evidence to improve practice (seven items), (c) connecting with community (seven items), and (d) leveraging the school and family team (seven items). To identify the gap between the current and optimal scope of practice, the SSNPT asked two questions for each item: frequency of practice item and perceived importance of the practice item. For the current school nursing practice, respondents rated from 1 = never, 2= rarely, 3 = sometimes, 4 = frequently, 5 = almost always, to 6 = always. The perceived importance of each school nursing practice was rated on a scale from 1 = not at all important, 2 = only slightly important, 3 = somewhat important, 4 = moderately important, 5 = very important, to 6 = absolutely imperative. The composite scores were calculated separately for the current practice and the importance to practice in scoring the SSNPT. Each score ranged between 31 and 186, and higher scores indicated more frequent practice and perceived importance of practice. There is no cutoff score.
We adapted the SSNPT with permission from the author (White et al., 2021). The cross-cultural adaptation of the instrument was conducted in six stages according to Beaton et al.’s (2000) Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures (Online Appendix 1).
Stage 1: Forward translation. One professor of nursing science and one school nurse qualified to translate English independently translated the survey methods, areas, and questions of the instrument.
Stage 2: Synthesis. The two translators discussed their translated versions of the instrument (initial versions) and consolidated them into one (synthesized version). A scribe recorded the discussion and the decision-making process.
Stage 3: Back translation. The synthesized version was back-translated by two professional translators who are not health practitioners. The translators were not provided with the original instrument; each performed the translation independently. The synthesized version was then revised after reviewing the ambiguity of terms and the validity of translations, reflecting the results of the back translation.
Stage 4: Expert committee review. The expert committee consisted of a professor of statistics, a professor of Korean language and literature, a professor of nursing with experience as a school nurse, two translators, and two backtranslators. The revised synthesized version of the instrument, a report on the translation process, and the original instrument were emailed to the expert committee. The expert committee reviewed the suitability of the translation and assessed the face validity.
Stage 5: Presentation. The prefinal version of the instrument was pretested through an online survey of 30 school nurses. Among these respondents, five proficient school nurses and field experts in school nursing agreed to conduct additional content validity (relevance, readability, clarity, and inappropriate items) and suggested improvements through an online survey.
Stage 6: Psychometric testing and confirmation of the K-SSNPT.
A CFA was conducted to assess the construct validity. CFA was more suitable than the exploratory factor analysis (EFA) because the items and factors of the original instrument were derived from a theoretical framework (Brown & Moore, 2012; Chen et al., 2021). The model fit and convergent validity were also examined in the CFA. Actual practice and perceived importance of practice were analyzed separately using an independent model, but both questions were deleted when removing an item.
Contrasted group validation was also performed as a method of measuring construct validity. The scope of practice is a set of practice competencies (National Association of School Nurses, 2016). School nursing competencies differ according to the individual’s experience as a school nurse (Yoon, 2021). Therefore, the school nurses’ experience groups were regarded as contrasted groups in the current study to analyze whether there were differences between actual practice and perceived importance of practice according to the five categories of school nursing experience (Yoon, 2021).
The commonly used Cronbach’s α was calculated to examine the internal consistency of the instrument (Price et al., 2015). The composite reliability (CR) of each factor was also calculated during the CFA to evaluate internal consistency (Afthanorhan et al., 2014; Mustapha & Bolaji, 2015).
The K-SSNPT was finalized after deleting a few items during the evaluation process. Items with low standardized factor loading (SFL ≤ 0.60) were deleted one at a time (Afthanorhan et al., 2014). The questionnaire items were eliminated after considering both the low content validity index (I-CVI < 0.79) of the item and the meaning contained in the item during the development phase.
IBM SPSS 25.0 (Armonk, NY; IBM Corp.) and AMOS 25.0 (Chicago, IL; IBM SPSS Statistical Programs) were used for data analysis. I-CVI was based on the ratings number of the experts’ ratings of 3 or 4 (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, 4 = highly relevant) given to each item. An acceptable I-CVI was 0.79 or higher (Zamanzadeh et al., 2015). The model fit in CFA was evaluated based on the following criteria: the normed χ2 (CMIN/df) ≤ 2–3, the comparative fit index (CFI) ≥ 0.90–0.95, Turker–Lewis Index (TLI) ≥ 0.90–0.95, the root mean square error of approximation (RMSEA) ≤ 0.06–0.08, and the standardized root mean-square residual (SRMR) ≤ 0.08 (17, 23, 24). The convergent validity in CFA was then evaluated according to the following criteria: SFL ≥ 0.40–0.60, average variance extracted (AVE) ≥ 0.50, critical ratio ≥ 1.96, p-value (p) < .05 and squared multiple correlation (SMC) ≥ .40 (Abdullah et al., 2014; Afthanorhan et al., 2014; Arbuckle, 2019; Bae, 2017).
Analysis of covariance (ANCOVA) was performed to evaluate the validity of the contrasted groups. The chi-squared test and one-way analysis of variance were employed to identify the variables showing differences by experience group for assigning covariates to the variables. All variables that showed group-specific differences in the initial model were included in ANCOVA. Only the variables associated with the scores on the scope of school nursing practice were selected to be included in the final model.
Items-total correlations analysis was performed to evaluate the instrument’s reliability, and Cronbach’s α above 0.70 was considered acceptable (Taherdoost, 2016). The CR values of dimensions above 0.70 indicated which items consistently represented the same latent construct (Mustapha & Bolaji, 2015).
The study was approved by the Institutional Review Board of Chungnam National University (IRB No. 202108-SB-190-01) and was conducted in accordance with the Declaration of Helsinki. All participants signed an informed consent form after the researcher explained the study’s purpose, content, and procedures. Participants’ identity was protected, and they had the right to withdraw at any time.
A total of 360 nurses were included. Most participants were female (98.6%), and the mean age of participants was 39.50 years (SD = 10.58). Two hundred eighty-two school nurses (78.3%) had bachelor’s degrees. Participants’ mean years of experience as a school nurse was 8.72 years (SD = 9.45). The mean number of students at schools at which the participants were employed was 502.60 (SD = 321.58), and the mean number of students who visited the nurse’s office for 3 years was 3,164.17 (SD = 2496.56; Table 1).
The phrase “focused on the scope of health management in school nursing practice” was added to the title of the instrument to clarify that the K-SSNPT measures Korean school nurses’ scope of work in the healthcare field. The clarification is necessary because Korean school nurses’ legal duties are both student health management and health education (School Health Act, 2020), and this instrument does not cover the scope of work on health education. The additional description of Item 7 on QI was deleted because it differed somewhat from the process presented in Korea and could cause confusion to the respondents. The literal translation of “more than just” on item 11 into Korean caused the sentence’s meaning to be vague, so the phrase was changed to “and other work.” The title of dimension D, “Leveraging the School and Family Team” was changed to “Leveraging Case Management Team.” These changes resulted from an agreement to embody the meaning of the items more comprehensively after reviewing the subitems and the Framework. All bus drivers mentioned in the descriptions of items 26 and 27 were removed because school buses are rare in Korea. The U.S. legislation related to disability that is included in the description of item 28 was changed to “including students with disabilities.”
The translated instrument was modified to ensure consistency and accuracy of terminology and to reflect the meaning of the original instrument more clearly, based on the opinions of the seven experts. Some items were revised to improve brevity and clarity. During the pilot survey, the meaning of the “case management team” was described in detail to reflect the opinions of school nurses that it was difficult to understand the meaning of the phrase in the Korean context. The translated SSNPT was evaluated for content validity by an expert panel consisting of seven members of the expert committee and five school nurses in the Proficient group. I-CVI was between 1.00 and 0.75. I-CVI of four items (16, 17, 21, and 30) was 0.75, which was less than sufficient.
Convergent validity. Dimensions A, B, and D of the practice questions of the K-SSNPT did not meet the acceptable level of convergent validity (AVE = 0.48, AVE = 0.38, and AVE = 0.48, respectively). Dimensions A and B of the important question on the K-SSNPT also did not meet the acceptable criteria of convergent validity (AVE = 0.49 and AVE = 0.39, respectively). The model fits of practice, and perceived importance of practice questions on the initial K-SSNPT were unacceptable. Therefore, the model of K-SSNPT was modified by sequentially removing seven items: 30, 5, 29, 3, 11, 13, and 16, considering the SFL, I-CVI, modification indices, and the concepts of items. The final K-SSNPT consisting of 24 items in four dimensions showed an acceptable model fit (Table 2; Online Appendix 2). Dimensions A, C, and D of the practice questions on the final version of the K-SSNPT showed acceptable convergent validity (AVE = 0.52, AVE = 0.53, and AVE = 0.57, respectively). However, dimension B (AVE = 0.43) did not reach the acceptable level. The SFL of each practice questions on the final version of the K-SSNPT were in the range of 0.58 to 0.89 and satisfied the required level (Figure 1). The SMCs of items 12, 14, and 31 were 0.38, 0.36, and 0.34, respectively, below the acceptable level. The SMCs for the other items were between 0.46 and 0.79 (Online Appendix 3). Similarly, dimensions A, C, and D of the importance questions on the final version of the K-SSNPT showed acceptable convergent validity (AVE = 0.53, AVE = 0.59, and AVE = 0.62, respectively). However, dimension B (AVE = 0.47) did not reach the acceptable level. The SFL of each important question on the final version of the K-SSNPT ranged from 0.61 to 0.88 and satisfied the required level (Figure 2). The SMCs of all items were between 0.45 and 0.78 and were in the acceptable range, except for items 14 and 31 (Online Appendix 3). The SMCs of items 14 and 31 were 0.37 and 0.39, respectively, unacceptable (Online Appendix 4).
Contrasted group validity. Marital status (practice: F = 7.71, df = 1, p = .006; importance to practice: F = 6.71, df = 1, p = .010) and education level (importance to practice: F = 5.44, df = 1, p = .020) were assigned as covariates. The Proficient 2 group with more than 16 years of experience rated higher in practice and importance compared to the nonexperienced group (practice: F = 6.63, df = 6, p < .000; importance to practice: F = 3.71, df = 6, p = .001; Table 3).
The Cronbach’s α of the practice and importance questions of the final K-SSNPT were 0.94 and 0.95, respectively. In addition, the CR of each dimension ranged from 0.74 to 0.90 for practice questions and from 0.73 to 0.89 for importance questions.
Identifying the scope of expanding school nursing practice and measuring the subsequently required school nurse’s competency is essential to provide high-quality school nursing practice (Davis et al., 2021). The SSNPT reflected the current school nursing practice and was highly utilizable because it could quantify the scope of nursing practices in a school setting. The present study translated SSNPT into Korean and reflected the context of South Korea. However, the K-SSNPT only applied to healthcare practices performed by school nurses in South Korea. The legal duties of school nurses in South Korea are student health education and health care. Health educational strategies are essential to school nursing practice (Leroy et al., 2017; Willgerodt et al., 2018) and are Korean school nurses’ legal duty that is equally important to health care.
Consequently, all Korean school nurses have additional educator licenses and are called “health teachers,” unlike school nurses in other countries. However, SSNPT has no items related to student health education practices. In the theoretical framework, which is the Framework for 21st-century School Nursing Practice, education is presented only at the component level of care coordination principles. Therefore, the K-SSNPT should be used only as a tool to understand and measure healthcare practice among the practice areas of school nurses in South Korea and should not be interpreted broadly to the entire practice of school nurses in South Korea.
The K-SSNPT consists of 24 items across four dimensions and showed an acceptable model fit. Seven items were removed during the process of adaptation and instrument evaluation. Of the seven deleted items, five items (3, 5, 11, 29, and 30) had low explanatory power during the development of the original instrument. The EFA of the practice and perceived importance questions of the original SSNPT revealed the factor loadings of the removed five items (3, 5, 11, 29, and 30) below 0.40. Some studies suggested 0.30 as the factor loading cutoff. However, the factor loading cutoff is above 0.40 in general (Howard, 2016). Additionally, the original instrument, only having conducted EFA during the development, could shrink the items due to transcultural adaptation and CFA validation. EFA is often used early in scale development, while CFA is used in the later stages (Brown & Moore, 2012).
Concepts of the items in dimension B (applying evidence to improve practice) of the original instrument have heterogeneity issues. Despite the model modification, the convergent validity of dimension B was not satisfactory. Dimension B of the original SSNPT consisted of items from the framework’s leadership and standards practice principles (Davis et al., 2021; National Association of School Nurses, 2016; White et al., 2021). Items 11 and 13 of dimension B that were deleted in the current study were relevant to the leadership principle of the Framework (National Association of School Nurses, 2016; White et al., 2021). Item 16, which was also deleted, pertains to advocacy under the leadership principle of the Framework (Davis et al., 2021; National Association of School Nurses, 2016). Items 12 and 14 of dimension B were maintained in the K-SSNPT and represented the leadership principle of the Framework but had low SMC values (Davis et al., 2021).
Contrarily, items 15 and 17 in dimension B pertaining to the standards of practice principle of the Framework were included in the K-SSNPT (White et al., 2021). That is to say that items in dimension B from the leadership principle were deleted or showed low explanatory powers. In contrast, those from the standards of practice principle showed sufficient explanatory power. Items from the two principles showed differences in the original SSNPT, with FL of 0.38 to 0.50 for items of leadership and FL of 0.61 to 0.82 for standards of practice principles (White et al., 2021).
Both leadership and standards of practice are classified as principles in the Framework, but they have differences in the scope of application of the concepts. In detail, leadership is a type of mindset and professionalism. School nurses need to play the role of a leader in health as the only healthcare professional in a school setting, and leadership refers to competencies related to the role of a leader (National Association of School Nurses, 2016). On the other hand, standards of practice are related to the capabilities in specialized knowledge, skills, and decision-making required to provide the best nursing care. Accordingly, the effects of standards of practice were not limited to parts of the Framework but all principles, incorporating practice and performance standards (National Association of School Nurses, 2016). Dimension B of the K-SSNPT was constructed according to the properties of standards of practice and is more suitable for “applying evidence to improve practice” under dimension B of the original instrument. Nevertheless, it is necessary to develop and revise appropriate items to secure the convergent validity of Dimension B.
In the present study, items were deleted only to the extent that the model fit reached acceptable criteria to minimize the loss of the constituting concept of the original instrument. Consequently, two items (17 and 21), which did not meet the appropriate I-CVI criteria, and three items (12, 14, and 31), which did not reach the SMC standards that indicate the item’s explanatory power, were included in the K-SSNPT. Items 17 and 21, with an I-CVI of 0.75, were referred to as questions related to QI. Item 17 in the original instrument was stated to be a part of the standards of practice principle of the Framework. However, it is closer to QI competency in terms of not only applying the evidence but also including the ability to improve work using up-to-date evidence (National Association of School Nurses, 2016; White et al., 2021).
Interestingly, both items 17 and 21 were additional competencies for school nurses at the advanced practice level according to the scope and standards of practice published by the ANA and National Association of School Nurses (2017). A school nurse at the advanced practice level is a school nurse who has completed a master’s or doctoral education program (National Association of School Nurses, 2017). Unlike the low validity of practice-level QI in the current study, the content validity of QI items with advanced practice level had adequate validity in the Emergency Nursing Care Competency Scale for school nurses study (Yoon, 2021). Because QI should be evaluated as an essential nursing competency (Moran et al., 2016), and the scope of practice includes competencies of novice to proficient nurses (National Association of School Nurses, 2017), remaining high-level QI items in the K-SSNPT were considered appropriate. However, a reevaluation of the content validity of QI items is needed to be conducted in future studies.
Among the three items that did not satisfy the SMC standards (12, 14, and 31), Item 31 was related to first aid education of the teaching staff. First aid education for faculty and staff was also presented in the emergency nursing care competency of school nurses in a previous study (Yoon, 2021). However, this study differed from previous studies in that the first aid was limited to students with chronic health problems as case management.
Another reason item 31 did not meet the SMC criteria might be a translation issue. Item 31 was translated to “students with health problems” rather than “students with chronic health problems.” Therefore, it is possible that the respondents were likely to interpret this item as first aid training for school staff in general emergencies rather than students with chronic illnesses. There might be differences in responses to items regarding factors of managing chronic health issues if the respondents interpreted the item as a general first aid education for staff. To address this issue, the final K-SSNPT revised the item to clearly indicated that it referred to first aid training for faculty and staff in the context of case management. Future studies should reevaluate the validity of the revised Item 31.
Unlike the four dimensions presented in the current study, a previous study (Park & Bae, 2012) distinguished the competency of Korean school nurses within the scope of student health management between basic job competency and health management competency. The scope and standards of practice of the U.S. school nurses distinguish between standards of practice and standards of professional performance (National Association of School Nurses, 2017). The Framework consists of five components: standards of practice, care coordination, leadership, QI, and community/public health (National Association of School Nurses, 2016). Although the original SSNPT was developed based on a theoretical framework for scope and standards of practice and the Framework, additional research is needed to identify the factor composition of the school nurse’s scope of practice tool when considering the factors of SSNPT named based on empirical data (Davis et al., 2021).
Known group comparison is a typical method to support construct validity and is provided when a measure can discriminate between a group of individuals known to have a particular trait and a group who do not have the trait (Westen & Rosenthal, 2003). In the current study, the Proficient 2 group showed higher practice and perceived importance scores on K-SSNPT than the experienced groups. This result is consistent with a previous study on Korean school nurses’ emergency nursing care competency (Yoon, 2021), in which the Proficient 2 group showed a different competency between groups. These results imply that K-SSNPT is a tool that might be useful in identifying the differences in the scope of practice according to school nursing experience.
This study has some limitations. The participants of this study were recruited using convenience sampling and the limited generalization of the findings. Additionally, an analysis of the cutoff of the scope of practice throughout their career was not performed.
Analyzing cutoff scores based on experience can be an important criterion for developing and evaluating practical competencies based on experience. Further research is needed to analyze the experience groups’ scores on the range of practice scope using more generalizable samples because there is no golden standard to measure the results of the practical competencies of school nurses (Yoon, 2021).
In addition, some components of the K-SSNPT have not satisfied the standards of acceptability. In other words, the convergent validity of dimension B did not meet the standard criteria. Hence further testing is needed to identify. Although the K-SSNPT followed the constituent factors of the original SSNPT and has a suitable model fit, further research is needed to verify the validity of the dimensions of the K-SSNPT.
Although the K-SSNPT does not sufficiently contain the aspect of health education as an essential duty of Korean school nurses, the K-SSNPT is verified as an instrument to measure Korean school nurses’ health care practice. Hence, future studies should analyze the scope of health education conducted by Korean school nurses and develop related items to assess the scope of school nursing practice and education.
Notably, the K-SSNPT can be applied in school nursing practice research on importance-performance analysis (IPA) in school nursing practice because respondents could rate the frequency of practice and perceived importance of the practice for each item. Current school nursing practice data gathered using K-SSNPT could help set priorities for improving school nursing practice and increase awareness of the Framework for 21st-century school nursing practice (NASN, 2020). The IPA technique is a popular method of deriving practical priorities for developing educational programs and policies (Lee et al., 2021; Markazi-Moghaddam et al., 2019). Therefore, using the K-SSNPT might contribute to developing and implementing continuing education programs by considering the strengths and weaknesses of school nurses’ practice based on five principles of the Framework in the Korean school health context.
The present study developed and validated the K-SSNPT, which consists of 24 items and four dimensions that can identify and measure Korean school nursing practice. The instrument shows high reliability. Despite a few items and factors not meeting suitability standards, most satisfied content and convergent validity showed good model fit. The K-SSNPT is valuable as the only tool to assess school nursing practice using the SSNPT in Korea. This measurement instrument will provide an understanding of the current scope of practices and the gap between perceived importance and practices in Korean school nursing practice. Moreover, the K-SSNPT could utilize measurement tools for data collection for designing school nurses’ workforce policies in order to improve school health as well as identify strategies to improve school nursing practice.
We would like to thank all who participated in the survey.
All the data supporting the study findings are within the manuscript. Additional detailed information and raw data are available from the corresponding author upon reasonable request.
Not applicable.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors received no financial support for the research, authorship, and/or publication of this article.
The study was approved by the Institutional Review Board of Chungnam National University (IRB No. 202108-SB-190-01). All methods were performed and collected data were managed in accordance with the regulations of the Institutional Review Board of Chungnam National University.
Jaehee Yoon https://orcid.org/0000-0001-9826-8408
Hyun-Ju Seo https://orcid.org/0000-0001-9019-1135
Supplemental material for this article is available online.
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Jaehee Yoon, PhD, RN, is a school nurse in Wolchon Elementary School, Seoul.
Hyun-Ju Seo, PhD, RN, MPH, is an associate professor in College of Nursing at Chungnam National University, Daejeon.
Ji Eun Kim, PhD, RN, is an assistant professor in College of Nursing at Konyang University, Daejeon, South Korea.
1 Wolchon Elementary School, Seoul, Korea
2 College of Nursing, Chungnam National University, Daejeon, South Korea
3 Konyang University, Daejeon, Korea
Corresponding Author:Hyun-Ju Seo, PhD, MPH, RN College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, South Korea.Email: shj5th@korea.ac.kr
