School nurse perceptions and knowledge of pediatric toileting

We surveyed school nurses on toileting conditions in schools, their level of understanding related to normal toileting patterns in school-age children, and whether they are in need of additional resources to promote healthy toilet habits for their students.

An Institutional Review Board approved web-based survey with 34 questions was employed; 562 nurses completed the survey and 97% were currently employed as school nurses. Participants were invited via email blasts through national school nursing associations and the Iowa Department of Education.

Only 48% and 33% of respondents suspected an underlying health problem in children with frequent urination and bladder or bowel accidents, respectively. Despite 61% reporting never receiving information about children's normal elimination patterns, 43% had been asked to provide such information to teachers. Only 42% felt they had adequate resources to respond to such requests. School nurses requested information about treatment of dysfunctional elimination (67%), health effects of childhood toileting habits (65%), fluid intake guidelines (44%) and improvement of bathroom facilities (39%); 70% were unaware of local providers specially trained to treat children with these problems.

Our survey results suggest that school nurses need additional information and resources in order to promote healthy elimination patterns in school children.