http://jsn.sagepub.com/The Journal of School Nursing

http://jsn.sagepub.com/content/24/6/425The online version of this article can be found at:

 DOI: 10.1177/1059840508326257

2008 24: 425The Journal of School NursingSusan Praeger

Applying Findings to Practice  

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425

Research to Reality

Applying Findings to Practice

Susan Praeger, EdD, APRN, BC, NBSCN, FNASN

Colucci, L.A. & Klein, D. E. (2008).Development of an innovative pointe shoe.

Ergonomics in Design. 16(3), 6-12.

Featured on the cover of Ergonomics in Design,this research study was “an exploratory examina-tion of the ergonomic and design factors of thepointe shoe” (p. 6) in order to consider designsthat could address reported foot problems. Datawas collected from ballerinas, current researchpublications, examination of anatomical foot vari-ables, and the dissection of used ballerina pointeshoes. The researchers conducted either personalinterviews or sent email questionnaires to 29 pro-fessional, preprofessional, and teacher ballerinasin the Boston area. For those who were inter-viewed, the researchers observed the subjects indifferent ballet positions, during standard balletmovements, and while putting on pointe shoes.These were documented with photographs.

Data analysis was conducted using conceptmapping related to areas identified as problemsin the shoes, ergonomics, aesthetics, and conve-nience. Based on the analysis of data of perceivedneeds and structural problems, the researchersexplored solutions, resulting in a prototype pointeshoe boot that included at least one modificationto each section of the pointe shoe: the box, theplatform, the shank, and the quarter. The innova-tions were designed to more evenly distributeweight on the toes (reducing discomfort, improv-ing fit and biomechanics); provide more rigidside-to-side support (reducing the risk for hallux

valgus); increase the life and comfort of the shoe(which could be as short as a few classes); andreduce the sound of the shoe when it touches thefloor. The resulting prototype incorporated theseconsiderations with a shoe boot design that moldsto the foot. It was then informally tested with12 ballerinas. The researchers concluded that thisresearch project, an exploratory study, can formthe basis for further evaluation of the prototypedeveloped.

TAKE-TO-WORK MESSAGE

This study is intriguing in several respects withimplications for school nurses. The most obviousis the application of this study when consideringstudents who may be studying ballet as an exer-cise, sport, or future profession. According to theCleveland Clinic Foundation (2004), formal bal-let training typically begins around age eight andintensifies approximately four years later with theintroduction of pointe. The Joffrey Ballet School(2008), “world renowned ballet training center,”offers classes for 2½ year olds to begin theirappreciation of rhythm and movement. While notall students go on to an intensive trainingprogram in ballet, there are sufficient numberswho engage in early training to warrant school

Susan Praeger, EdD, APRN, BC, NBSCN, FNASN, is a pro-fessor of nursing at Wright State University, Dayton, OH.

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nurse attention. Sharing information with parentsand students about health guidance for studentsengaged in ballet should be part of the healthinformation provided by school nurses either onbulletin boards or in school newsletters. Whenstudents are identified who participate in ballet, itis important to assess them for health concernsgenerally related to ballet and specifically relatedto pointe. The Cleveland Clinic Foundation(2004) outlines, as do a number of orthopedicand podiatry journals, the health issues faced bythose engaged in ballet and the specific risks foryoung persons. Whenever a student presents withmusculoskeletal complaints, it is important toassess possible contributing factors, such as ballet,and make referrals as appropriate.

In addition to clinical assessment and interven-tion, this research methodology reminds schoolnurses of the importance of solving problemsfrom a multidimensional approach. A human fac-tors approach to the research process takes abroader perspective than does traditional nursingresearch. According to the Human Factors andErgonomics Society (2008), “ergonomics (orhuman factors) is the scientific discipline con-cerned with the understanding of interactionsamong humans and other elements of a system,and the profession that applies theory, principles,data, and other methods to design in order tooptimize human well-being and overall systemperformance.” The researchers included bothqualitative and quantitative approaches to gath-ering data and designing an “intervention” in theform of a better pointe shoe.

By interviewing ballet dancers, they were ableto identify concerns, problems and perceptions ofwhat is most important to individuals. By study-ing the anatomy of the foot they were able tounderstand how structure needs to be supported.By observing ballet dancers in positions, theywere able to analyze data regarding stress andform. And by examining used shoes, they wereable to identify areas of use and problems. Thismultidimensional approach reminds us that asnurses we need to consider more than just atti-tudes, knowledge, or measurements in ourresearch and include the complex nature ofhuman behavior, actions, and thoughts.

For example, school nurses in considering anintervention for children with insulin dependentdiabetes mellitus, would need to examine howchildren and their families perceive the testingand administration process and determine theimportant variables that need to be considered.Developmental readiness, the equipment used,and the methods used need to be considered.Does the student use a lancet with “light pressure”and then spend time squeezing out enough bloodfor a reading versus someone who uses deep pres-sure with the lancet and rotates the site frequentlyfor better access for blood glucose testing? Doesthe position of the table and chair in the healthoffice make a difference in terms of comfort, easeof access, and feelings of privacy and confidencethat then influence blood glucose readings?Similar questions and assessments might need tobe considered with the measurement and admin-istration of insulin in the health office. Theresearchers take us through the steps researchingthe problem of pointe shoes and developing a pro-posed solution. This research approach can beconsidered when solving other health concernsfaced by students in the school setting.

Finally, this study was intriguing because Ms.Colucci, the first author, was a 10th grade studentwhen the research was conducted as part of aschool science fair project. Obvious congratula-tions are in order for a job well done. The impli-cations for school nurses are vast. Being aware ofopportunities in our schools for students to iden-tify problems and come up with solutions, theschool nurse can be a visible link to solving prob-lems related to health promotion and disease pre-vention. Letting the science teachers know of yourinterest in and expertise in the research processcan position the school nurse to share currentresearch studies with both students and staff.Mentoring a student through a project can helpsolve problems and increase the student’s aware-ness of the role of the nurse and perhaps theirinterest in nursing as a career opportunity. Beingaware of researchers in the community, especiallyneighboring academic communities, can buildmentorship opportunities for students and schoolnurses interested in advancing the profession andfinding solutions to health problems.

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REFERENCES

Human Factors and Ergonomics Society. (2008) What is humanfactors/ergonomics? Retrieved September 4, 2008 fromhttp://www.hfes.org/Web/AboutHF

Joffrey School of Ballet. (2008). Children’s division, 2008-2009children’s Pprogram. Retrieved September 4, 2008 fromhttp://www.joffreyballetschool.com/content/view/29/32/

Cleveland Clinic Foundation. (2004). Ballet: Ideal body type, injurytreatment and prevention. Retrieved September 4, 2008 fromhttp://my.clevelandclinic.org/disorders/ballet_injuries/hic_ballet_ideal_body_type_injury_treatment_and_prevention.aspx

Rauscher, K. J., Runyan, C. W., Schulman,M. D., & Bowling, J. M. (2008). U.S.child labor violations in the retail and

service industries: Findings from a nationalsurvey of working adolescents. American

Journal of Public Health, 98(9), 1693-1699.

Supported by funding from the National Insti-tute for Occupational Safety and Health and theNational Center for Injury Prevention and Control,this study sought to identify child labor violations in the United States. The researchers identifiedadolescents and their parents from 30 states andinterviewed them via telephone to determine work-related practices of adolescents in the service andretail industries. The researchers cited federal andstate law mandates for employment of minorsbased on the Fair Labor Standards Act of 1938 asthe framework for adolescent employment andthen addressed variations from these mandates.The purpose was to identify hourly (time of day andlength of time of work) violations, potentially haz-ardous equipment exposure, and work permit vio-lations. Using both federal and state regulations,the researchers examined employer compliance inrelation to minor employment practices. All viola-tions were tabulated based on state laws except for16 to 17-year-old nighttime violations, which usedan 11:00 p.m. standard, even though some stateshave a 10:00 or 10:30 p.m. curfew for this agegroup.

The sample of 858 adolescents worked 2 or moremonths in the past year and were between 14 and17 years of age at the time of the telephone inter-view with more older adolescents represented in

the sample than younger ones. Although all statesdo not require a work permit, of those that do,more than one in three adolescents reported nothaving a work permit while working. The majoritywere employed in retail (67.5%) and 32.5% wereemployed in service (Division I, health, education,social services). School-year hourly weekly limitsviolations were reported by less than 2% of the ado-lescents. However, 11% reported working past thelatest hour allowed, and 15% reported working offthe clock.

Safety issue concerns were raised when morethan one third of the sample reported hazardousorders violation. The use of power-driven equipmenttools such as food slicers or grinders was reported by17.5% in food service or grocery store employment.The extent of violations reported varied by industryand sociodemographic characteristics. Night-workviolations and discrete hazardous orders violationswere more common in the service industries. Power-driven equipment tool violations, work-permit viola-tions, and working off the clock were more commonin retail situations. Hazardous orders violationswere reported more often by older adolescents, andboys reported more violations than girls did. Havingthe mandated work permit did not consistently pro-tect adolescents against the use of all types of pro-hibited equipment.

The researchers report that their findings areconsistent with other studies examining practicesof adolescent employment. They “estimate thatas many as 264,000 of these youths may beemployed in violation of the FLSA’s [Fair LaborStandards Act’s] night work provisions and asmany as 888,000 may be employed in violation ofthe hazardous orders each year” (p. 1697). Theauthors conclude with the reminder that “it wasnot the young workers who were violating thelaws but rather their employers” (p. 1698).

TAKE-TO-WORK MESSAGE

Young people often need to work to contribute to family income, to save for the future, and to gaina sense of independence and accomplishment, animportant developmental task of adolescence. Asschool nurses, it is not our job to monitor studentemployment; however, youth employment practicesshould be part of our regular assessment of youth

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presenting for health care either with an injury, illness, or fatigue. Working with school counselors,teachers, and administration, the school nurse can contribute to an awareness of hiring andemployment practices in the community. Throughactions of the coordinated school health team, com-munity members can become aware of risks forminors who are employed during evening hours,with hazardous equipment, and without the benefitof work permits when required. Sharing state laborlaws through government or social or work skillsclasses can inform students of their rights and respon-sibilities when considering employment. Schoolscan be instrumental in working for safe communityemployment practices by sharing this informationwith all members of the community through bulletinboards, local cable television, newspaper articles, andwith service groups in the community to increaseawareness of the importance of safety laws governingthe employment of minors and the need for a com-munity to promote enforcement of such laws.

Although not all schools have courses on employ-ment, the school nurse can work with communitymembers, guidance counselors, and other school staff

to sponsor workshops for students on entering andbeing a part of the workforce. Students not only needto know how to protect themselves from unfair laborpractices and hazardous equipment but they need tolearn how to request proper orientation to the workenvironment, how to deal with first aid problems on-site, how to detect risky situations, and how to reducethe transmission of disease in the work place. Schoolnurses can be valuable team members in sharing thisinformation and in monitoring community practicesthat can affect student health. School nurses can findinformation regarding state labor practices for minorsat the U.S. Department of Labor Web site (www.dol.gov) and through state resources, including stateoffices of the U.S. Department of AgricultureCooperative State Research, Education andExtension Services (www.csrees.usda.gov/Extension/),which offer educational programs for youth on real-world issues.

REFERENCES

Medline Plus. (n.d.). Farm health and safety. Retrieved October 1, 2008,from http://www.nlm.nih.gov/medlineplus/farmhealthansafety.html

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