Every Second Counts: The School Nurse as a Health Educator - A Cross Sectional Observational Study

Background Schools are key environments for children's daily lives, where urgent events such as syncope, hypoglycemia, seizures, and minor trauma can occur. In Italy, the absence of school nurses and the lack of mandatory first aid training for all teachers place initial emergency management largely on educational staff, whose preparation is variable. Enhancing first aid culture and readiness is therefore essential for prevention, early recognition, and timely response. Aim To assess the training level and preparedness of teachers-from nursery to lower secondary school-in managing pediatric urgent and emergency situations within school settings. Material and Methods A multicenter, descriptive, cross sectional observational study was conducted (April-October 2025) using a structured questionnaire integrating two validated instruments. Participants were recruited from nursery, kindergarten, primary, and lower secondary schools in the Marche region (Italy). Data were summarized as proportions with 95% CIs (Clopper-Pearson). Associations were tested with chi square (exact tests as needed), with effect size via Cramér's V. Significance α=0.05. Correct CPR sequence knowledge was estimated as prevalence. Results The sample included nursery (n=8), kindergarten (n=12), primary (n=23), and lower secondary (n=24) teachers, mostly aged 26-50 years; 64.2% held a university degree. While 91% reported first aid knowledge and 88% had attended at least one course, only 7.5% felt genuinely prepared; 64.2% felt insecure and 28.4% unprepared, and ~90% requested further practical training. Scenario items revealed procedural gaps: only 55.2% prioritized assessing consciousness in an injured/unconscious student; 71.6% would avoid manipulating a sprained ankle; responses on bleeding were split (direct pressure 52.2% vs gentle tamponing 46.3%). Diabetes knowledge was stronger (e.g., insulin via injection 95.5%; insulin does not raise glucose 92.5%), yet uncertainty remained for managing acute episodes on site. On epilepsy, misconceptions were largely rejected, but causal attributions mixed genetics (47.8%) and emotional factors (41.8%). Practical first aid sequencing showed fragmentation; only ~33% (95% CI 22-45%) knew the correct CPR sequence. Training was strongly associated with perceived preparedness (χ²(2)=22.95; p<0.001; V=0.59), age and seniority with lower confidence (V=0.66 and 0.61, respectively), and perception moderately with correct CPR sequence (p=0.003; V≈0.42). Training alone did not correlate with correct CPR sequencing (p=0.366). Discussion Current training reduces outright unpreparedness but often leaves teachers in a state of operational insecurity. Confidence and competence-especially CPR sequencing-appear to require hands on practice, realistic simulations, and regular refreshers rather than single-course exposure. Conclusions Teachers show acceptable theoretical awareness in selected areas but significant practical uncertainties in first aid, especially CPR and initial assessment. Structured, periodic, skills based programs and competency verification are priorities. Integrating the school nurse as a health educator could provide sustainable, on site support for training and emergency readiness.