# Realist Approach to Continuing Training of Physical Assessment Education to School Nurses (Yogo Teachers) in Japan

## TL;DR

A 12-year training program for school nurses in Japan improved their skills, earned trust, and fostered collaboration within schools.

## Contribution

Demonstrates how continuous physical assessment training for school nurses builds a community of practice and organizational improvements.

## Key findings

- 89% of participants reported the training met or exceeded their expectations.
- Training improved response capabilities and earned trust from students, guardians, and staff.
- The program led to unexpected organizational changes like improved emergency systems and equipment.

## Abstract

Background: As part of efforts to revitalize regional medical care, we implemented training in physical assessment for nurses and school nurses. We conducted a questionnaire survey using a realist approach to evaluate the training for school nurses that has been ongoing for 12 years.

Materials and methods: The summer training held by the Toyama Prefecture School Nurse Association includes education on severity assessment (evaluation of consciousness and vital signs), auscultation (heart, respiratory, and bowel sounds), the Heimlich maneuver, a review of Basic Life Support, and case studies. Following the training, we conducted an online questionnaire survey with participating school nurses to assess the outcome of the program.

Results: A total of 122 people responded (response rate: 35.6%) with 109 (89%) indicating that the results of the training session met or exceeded their expectations. The most common outcome of the training was improvement in their own response capabilities, followed by increased trust in students/guardians and school staff members. The training also fostered a sense of responsibility among the participants, motivating them toward further self-improvement. Furthermore, within the school, it led to collaboration with other staff members, a review of the emergency system, and improvement of equipment, which was beyond our expectations. The findings suggest that continuous repetition of basic physical assessment education will form a community of practice and bring about collaboration and revitalization within the organization as well as the acquisition of knowledge and skills.

Conclusions: Continuous training improved their ability to respond, earned the trust of students/parents and school staff, and motivated them to continue improving themselves. Furthermore, a community of practice was formed within the organization by continuing the training sessions.