Knowledge and Preparedness of School Health Nurses in Managing Anaphylaxis within Emirates Health Service

Background: Anaphylaxis is a rapid, life-threatening allergic reaction requiring immediate intervention. In school settings where children with diverse allergies are present, school health nurses are critical first responders. Their ability to recognize symptoms promptly and administer epinephrine significantly reduces the risk of severe outcomes. Despite their central role, knowledge gaps, inconsistent training, and limited resources may compromise effective management. In the United Arab Emirates (UAE), Emirates Health Service (EHS) oversees 398 school nurses across 313 schools, serving a student population where approximately 3% are at risk of anaphylaxis. Objectives: The primary objective was to assess the knowledge and response capabilities of school health nurses regarding anaphylaxis recognition and management. Secondary objectives included identifying gaps in training, preparedness, and response, and exploring the influence of demographic factors on nurses’ competencies. Methods: A cross-sectional survey was conducted among registered school nurses employed by EHS. Data were collected using a validated questionnaire covering demographics, knowledge of anaphylaxis, response capabilities, and training/preparedness. Responses were scored across three domains: Knowledge, Response Capabilities, and Training/Preparedness. Descriptive and inferential statistical analyses were performed using SPSS. Although the minimum required sample size was 179, a total of 252 eligible school health nurses took part, representing 63.3% of the eligible population. This increased the study’s statistical power, representativeness, and generalizability. Results: A total of 252 nurses participated, predominantly female (79.4%) and mid-career (42% aged 36 - 45 years). Overall, 82.9% demonstrated good knowledge of anaphylaxis, with the highest accuracy in identifying its definition (96.8%) and first-line treatment with epinephrine (96.4%). In the Response Capabilities domain, 73.9% provided preferred responses, although 92.5% reported limited exposure to real cases, and 51.2% did not routinely communicate with parents about allergy management. Training and Preparedness scores were highest, with 93.8% reporting participation in relevant training sessions and drills. A significant association was observed between training/preparedness and response capabilities (p < 0.001; Phi = 0.30), with an odds ratio of 19.7 (95% CI: 3.82 - 101.21) indicating substantially higher odds of poor response among less-prepared nurses.