Elise Schaller and Robert Bohnert

For their clinical scholarship project, DNP students Elise Schaller and Robert Bohnert performed a formative evaluation of St. Louis County’s guideline for youth sports. (Photo by August Jennewein)

Robert Bohnert and Elise Schaller always knew they wanted to do something to help people. That was why they became nurses in the first place, and it was among their reasons for entering the Doctor of Nursing Practice program in the College of Nursing at the University of Missouri–St. Louis.

When it came to pick a DNP clinical scholarship project amid the ongoing coronavirus pandemic, the call to help came on stronger than ever.

Yet neither had a clear picture of what that would look like until the St. Louis County Department of Public Health reached out to UMSL and invited the DNP students to make COVID-centric projects.

“It’s exciting to be doing something so relevant and time sensitive,” said Schaller, who is also an assistant teaching professor of nursing at UMSL.

The two, who will be graduating in August, decided to tackle COVID from an unusual angle – youth sports. In conjunction with the Department of Public Health, they produced a formative evaluation of St. Louis County’s guideline for youth sports.

Their idea was to figure out if the policy put in place was being implemented in schools, how well it was implemented and then how well it was followed.

“Initially, we had to figure out why sports are this important,” Bohnert said. “They are, obviously, important for your physical health, but there’s a lot of important aspects to people’s mental health that youth sports play a role in. There’s a lot of research that shows that it is important to be interacting with other people. But at the same time, we’re living in a pandemic, and how do you do that safely?”

The two built their project around the last question. Schaller examined public high schools in communities where the average household median income was less than $67,000, and Bohnert looked at public high schools where the average median household income was greater than $106,000.

Schaller and Bohnert looked at high and low contact sports to see if there were differences in compliance between them. Because of the time of year, those sports were junior varsity and varsity men’s basketball for high-contact and junior varsity and varsity women’s swimming for low-contact.

To measure compliance, they created an observation tool based on the youth sports guideline.

“We took the major components of the guidelines, like wearing a mask and social distancing,” Bohnert said, mentioning other violations such as no more than two spectators per athlete, wiping down frequently touched items and hand greetings. “We would count the number of violations that occurred.”

To test the tool’s validity and to make sure they were using it in the same manner, Schaller and Bohnert went to a retailer and watched customers entering and leaving the store. Then they put in practice.

They attended 24 games in total for about 30 minutes per game and observed players, coaches, officials and spectators. The two attended the games together with one primarily observing the athletes for violations and the other observing the coaches, officials and spectators.

Right away, the two spotted differences.

The basketball players tended to social distance well when not playing. But when it came to the other guidelines, they were less than stringent.

“Some of them would wear their masks on their chin,” Bohnert said. “It’s just the nature of the game, I think, but then they wouldn’t pull it up. There’s some who decided to pull their mask down to yell, or cheer, and then they’d bring it back up to talk. Anytime somebody made a basket, or they were switching out during the game, they would give each other low fives or fist bombs or something.”

The swimmers were very good about following most of the guidelines, carefully drying their faces and putting on masks after races, for example. But when it came to social distancing, they were less adherent and tended to gather and talk when not in the pool.

The study found high-frequency contact sports had significantly higher mask violations, while low-frequency contact sports had significantly higher social distance violations.

“We didn’t study male versus female,” Schaller said. “However, data from our study shows female swimmers congregated but wore their masks well, while male basketball participants had more hand contact and mask violations but were more compliant with social distancing. A study on compliance by gender could yield interesting results.”

High versus low contact turned out to be a much more powerful indicator of compliance – and showed statistical significance – than income.

They tracked their findings against cases published in Missouri’s Covid-19 Dashboard, looking at case rates for 15- to-19-year-olds in the school districts they reviewed to look for correlations.

Though they didn’t find any correlations, the two believe that doesn’t necessarily mean there wasn’t one.

“There were definitely limitations to our project,” Bohnert said. “We didn’t have the exact numbers coming out of the high schools we were observing, so we didn’t have the perfect data to actually make those correlations.”

They did think about potential barriers to compliance from their study that could, hypothetically, be used to create or revise future guidelines after further study. Those included making sure there was more space to social distance in the pool setting and providing guidance on how to properly fit masks so that they wouldn’t fall down athletes’ faces so easily.

Schaller and Bohnert are grateful for the St. Louis County Department of Public Health Policy Advisor Katerina Utz, who helped the two get in touch with high school athletic directors and explain the project.

Getting through the project and, even better, finishing the DNP program is a huge achievement and a relief.

“It feels great,” Bohnert said. “It’s the light at the end of the tunnel.”

Both are looking forward to using the knowledge gained in the program in their careers.

Bohnert, who is currently working at a COVID-19 testing site, hopes to find work soon as a family nurse practitioner. Schaller is looking forward to bringing her new knowledge to her work at UMSL as well as to her pediatric patients.

“It really has made a difference in my understanding of applying research and feeling like I am a clinical expert,” she said. “I can’t encourage MSNs enough to go back for their DNP because it is really excellent skills for reading research, performing research, applying research to our practice, taking care of patients and being nurse leaders. Being in academia, being at UMSL and teaching at UMSL is what made me go back, and I’m so thankful I did.”

Jessica Rogen

Jessica Rogen