Preventing Pediatric Drowning in Minnesota, USA


Fatal drowning is a major cause of accidental deaths in the US, especially among children aged below 14 years. The number of people who drown in Minnesota is among the highest nationally. Even more common are near-drowning incidents in residential and public pools that are associated with brain injury and other neurologic deficits. Therefore, addressing risk factors, particularly limited swimming skills in children, through education-based strategies, can prevent drowning-related mortality and morbidity.

Policy Proposal

The frequent pool-related incidents call for population-level policies to build survival swimming skills among school children. The rationale for such interventions is to enhance the learners’ water-safety awareness and attitudes and teach cardiopulmonary resuscitation (CPR) support, self-rescue, and life jacket usage, among other skills, across the state through experiential training (Tobin et al., 2017). The anticipated long-term outcome is a decrease in drowning incidents.

Public Policy Issue

Drowning is an issue of major concern that accounts for significant pediatric morbidity and mortality in the US. In Minnesota, one in five drowning-related deaths involves children under fourteen years (Centers for Disease Control and Prevention, 2019). Drowning prevention requires an effective public health intervention at the state level. Training school-age children in survival swimming and water safety skills is a proven strategy for addressing this problem at the level of policy. The proposal presented in this paper entails the provision of swimming lessons to all school-aged children aged K-12 in Minnesota as a part of their curriculum. Individualized training for learners, including those with disabilities and cognitive limitations, can build their water competency skills and offer effective protection against fatal drowning.

Issue Selection

The reason for selecting this issue for analysis is that swimming instruction – a proven drowning prevention strategy – is limited in Minnesota public schools despite the frequent pool incidents reported in the state. Thus, a statewide policy is needed to make swimming resources available to underserved learners from an early age and introduce curriculum changes to meet identified grade-specific outcomes. Free swim lessons will build water safety competency in children to alleviate the drowning-related risk factors and incidents in Minnesota. Drowning is a major cause of preventable injury-related fatality in young Americans. About 1,000 children in the 5-19 years age group drowned to death in 2017 (Denny et al., 2019). Limited swimming ability and cardiopulmonary resuscitation are associated with a greater risk of drowning. Therefore, changes to the physical education curriculum to include swimming instruction and activities can help tackle this challenge.

Issue Relevance

Drowning is associated with significant morbidity and mortality outcomes in children. It is the fourth-leading cause of fatality in children under four years and adolescent males aged 15-19 years (Davey, Callinan, & Nertney, 2019). With drowning being a major risk factor for unintentional injury-related juvenile deaths, its prevention is a policy issue relevant to public health and safety. Healthcare professionals have a crucial role in pediatric trauma prevention. Based on their clinical experiences, they can identify the leading causes of drowning in an area. The most at-risk groups are children with underlying medical conditions such as epilepsy and cardiac arrhythmias (Tobin et al., 2017). Therefore, pediatric nurses can promote safety by providing messages tailored to people with special needs, specific regions, or ages. Additionally, health professionals can teach parents to supervise children when swimming or bathing (Tobin et al., 2017). Nurse-led CPR education is also critical in preventing fatal drowning.

Educating parents and adolescents about water safety can also be an effective drowning prevention strategy. By virtue of their clinical experiences and knowledge, nursing professionals can assume educational leadership in addressing safety issues at the pools. They can teach safe swimming skills to older children and those with disabilities and highlight the drowning risk related to drug or alcohol use. According to Stempski et al. (2015), pediatricians can advocate for the passage of stringent laws that lower the drowning risk through evidence-based interventions such as “fencing, life jackets, and not boating under the influence” (p. 112). Their collaboration with community groups can increase the availability of life jackets at pools. Efforts to improve the pediatric trauma emergency systems must involve nurses. Therefore, the role of healthcare professionals in all aspects of drowning prevention is paramount.

Financial Impact

The overall objective of the policy proposal is to prevent fatal drowning rates among school-age children through formal swimming education in all Minnesota public schools. Key resources will be needed for this purpose. According to the Minnesota Department of Education (2016), access to pools by K-12 children is required since only about a fifth of the schools in Minnesota own natatoriums. Further, the cost of constructing a pool suited for swim lessons (not too deep and filled with tepid water) ranges between $275 and $350 per square foot (Minnesota Department of Education, 2016). Additional expenses are related to maintenance and staffing – swimming instructors. However, rental agreements with community facilities can help reduce this cost. Equipment to support swimming instruction will also be needed. Additional costs will come from training teachers in physical education and curriculum changes.

The financial impact of drowning prevention is significant. Drowning-related fatalities break families and can be traumatic to parents present during the incident. Child victims of nonfatal drowning are at risk of developing long-term neurologic deficits that limit their functional abilities throughout their lifetime (Szpilman et al., 2018). The cost of caring for the survivors is high. Therefore, prevention can avert the economic burden of caring for a child with a disability. As a result, water safety outcomes will improve, reducing the drowning risk and impact of fatal and nonfatal water-based pediatric trauma in Minnesota.

Personal Values

Most young people are often eager and excited to swim often without adult supervision or safety measures. My experience performing CPR on an eleven-year-old child who drowned in a surfing accident was traumatic and made me realize the self-rescue skills learned early are paramount. Through this experience, my professional values of integrity and compassion informed my resolve to assume educational leadership and advocacy for safety at the pools. Water entry skills and the ability to orient your body in a way that allows breathing is key in unpredictable environments. The victim had not received any swimming education and was not prepared for the risks in sea conditions. He had not mastered the skill in the open water. The nonfatal incident left him with cognitive impairments and increased the caregiver burden to the family. My values include a passion for water safety to prevent drowning incidents in at-risk groups. The educational intervention will reduce the risk of fatal drowning and protect young people from long-term cognitive deficits arising from nonfatal incidents.

Ethical Principle or Theory

Professional values for drowning prevention entail the significance of swimming education and commitment to water safety for at-risk groups. The core ethical principle underpinning my perspective is that of beneficence. It gives nurses a moral obligation to promote the good of others (American Nurses Association, 2015). Performing CPR to a drowning victim and providing clinical supervision in nonclinical settings reflects the ethical principle of beneficence. The ultimate goal of the advocacy for curriculum changes to include swimming lessons is to achieve water safety that will benefit children. Formal education will equip young people with self-rescue skills and address risk factors such as lack of swimming ability. Nurses are obligated to act in a way that promotes the benefit and interests of vulnerable groups. Children face a greater risk of drowning. Therefore, an educational intervention can build their water competency and prevent possible fatal injuries and nonfatal incidences that cause brain injury.

The Top-Down Approach to Policy Advocacy

In order to increase access to swimming education by school-age children in Minnesota, a top-down approach will be taken with regard to curriculum changes and resource allocation. The model entails a clear hierarchy of authority where the implementation strategy is initiated at the top to realize the articulated goals and outcomes (Stempski et al., 2015). In this case, the policy framers are considered the key actors in its implementation. They put in place adequate bureaucratic measures to execute the initiative.

Decision Maker

Providing swimming lessons to all K-12 children in Minnesota will require a top-down approach. The recipient of the policy brief will be the state’s Education Commissioner, Mary Cathryn Ricker. As an influential figure, she will develop the expected grade-specific competencies in swimming and implementation guidance for schools. The Education Commissioner will also formulate a professional development plan for instructors to ensure that Minnesota schools meet the state-required pool safety outcomes. She will also facilitate access to key resources required to ensure quality swimming instruction to children.


Most injury-related deaths in young people have been linked to drowning. It is estimated that about 1,000 fatalities of children under four years occur annually due to drowning-related incidents (Beal, 2019). Further, each year about 370 adolescents aged 10-19 years drown in the US. The main risk factor for younger children includes curiosity, while for teenagers limited swimming skills and alcohol abuse contribute to the high drowning incidents reported (Willcox-Pidgeon, Franklin, Leggat, & Devine, 2020). Swimming ability is associated with a lower risk of drowning in children. Therefore, appropriate prevention strategies tailored to Minnesota’s high-risk populations are needed to tackle this challenge. The Education Commissioner is the best fit for the policy proposal since she can influence legislative changes to include water safety education in the school curriculum. This approach will ensure increased access to swimming instruction by all students.


Efforts to have the bill passed into law or mandated policy may face challenges related to resource constraints – personnel, pools, and equipment – and learning outcomes. State-mandated swimming instruction will require the adoption of grade-specific standards and learning outcomes, which are lacking in Minnesota (Minnesota Department of Education, 2016). The Education Commissioner will also face objections from lobby groups citing a lack of professional development plans for teachers before the implementation of curriculum changes. Training instructors will enable schools to meet the state-required water safety outcomes for learners. Settling on a specific adoption year will also be a challenge since not all schools will have acquired the necessary resources and staffing capacity to comply with the policy. Lobbyists and other groups may also cite the disparities in access to swimming pools between Minnesota school districts in opposing the policy.

Options and Interventions

The policy proposal will prompt curriculum changes to improve water safety among schoolchildren in Minnesota. It will highlight the potential deaths that could be averted through increased access to swimming instruction. Upon receiving the proposal, the Education Commissioner will have three options of proceeding with the policy process. First, she may opt for the status quo due to political realities. Prohibitive costs related to curriculum changes and professional development of teachers and resources – swimming pool construction and repair – may force her to leave things as they are. She may deem the policy proposal to be a monumental and costly task. Further, budget cuts and political pressure to improve test scores are likely to limit the resources allocated to schools for physical education. The outcome of failing to move forward with the policy will include high incidents of fatal and nonfatal drowning in children and increased family burden of caring for survivors.

The second option available to the decision-maker is accepting the proposal with some amendments or compromise. She may consider the pros and cons of the recommendations and choose to adopt some changes. Anticipated modifications by the decision-maker include community partnerships to offer water-based instruction to students throughout the state. Through this model, community-based organizations will access a curriculum for swimming education and preventing drowning.

The third option is accepting the policy proposal and carrying it forward through the change process as it is. The outcome will be state-mandated swimming instruction accessible to all K-12 children across Minnesota’s public schools. This option will save young people from drowning.

Course of Action

As stated above, grade-specific learning outcomes, personnel, and access to pools and funding for equipment are key considerations in implementing the drowning prevention policy. The decision-maker can adopt different persuasive actions to address these issues. For the challenge of grade-specific learning standards, the commissioner could assemble a workgroup to formulate the state-required student outcomes in swimming and the relevant programs for achieving them. She could invite the committee to make presentations in the Legislature to promote buy-in from lawmakers. For the challenge of personnel development, the decision-maker could involve the Minnesota Board of Teaching in developing licensure certifications for physical education teachers. A qualified lifeguard can be invited to discuss CPR and other emergency procedures with swimming lesson providers. Addressing the challenge of limited access to school-operated pools, she could involve community partners in identifying available pools for use before constructing new ones. The constraint of funding for safety equipment required to offer swimming lessons can be tackled by inviting manufacturers to discuss cost-effective options for running a statewide drowning prevention program in school-operated pools.

The success of the Policy Brief

Making swimming instruction available to school-age children will involve several activities consistent with any top-down policy process. The introduction of water safety education in the curriculum is an incremental initiative. The process successes anticipated will include acceptance of the policy brief by Minnesota’s Education Commissioner. Her approval of the proposal will be a major milestone. The next step will be the formation of a workgroup made up of different stakeholders involved in swimming instruction to identify curriculum changes and resources required to provide water safety lessons to all children. The third stage is the passing of the report by the education committee of the Minnesota Legislature. Subsequent enactment of the swimming instruction proposal into law will mark a significant milestone in the policy process. The Education Commissioner will then undertake several activities to implement this legislation. She will develop grade-level learning outcomes in swimming, implementation guidance for school districts, and a professional development plan as well as identify the adoption year that all institutions will be required to comply with.

The long-term success that can be realized from implementing the policy is a reduction in the number of children drowning by 25% within one year. The lessons will impart essential swimming survival skills. Another long-term success is an increase in the number of school districts participating in the program by 70% within five years. Partnerships with the community will ensure greater access to swimming pools by children to help achieve this target.

The Bottom-Up Approach to Policy Advocacy

Partnerships with a group interested in drowning prevention can help lobby for the policy proposal. In this bottom-up approach, strategy implementation begins with the target individuals (Stempski et al., 2015). It is premised on the idea that a policy is likely to fail if local implementers are not involved in the process. Accordingly, program objectives and activities must be executed with the target group in mind.

Identified Organization or Community

The organization chosen as a partner entity in the drowning prevention policy proposal is the Harold Mezile North Community YMCA. This not-for-profit community institution offers water safety classes and swimming lessons to youth and teens in Minneapolis. The organization has expressed interest in delivering integrated aquatics programs to prevent the drowning of children.

Summary of Expressed Interest

The chosen organization is aware of the risk factors for the high drowning incidents among children. It offers age-appropriate swim lessons to enable children of all ages to perfect their strokes. Information on the Harold Mezile North Community YMCA website indicates that the organization would be aligned with a policy proposal to teach basic swimming skills to K-12 students across Minnesota. For example, it aims to ensure that “kids are not only safe in and around water but also free to have fun” (YMCA Twin Cities, 2020, para. 1). The organization offers swim lessons for older children, a starter package for toddlers, and a basic swimming program for school-age kids. Customized private swim lessons are also available. The organization notes that the number of accidental drowning fatalities involving children is high. For this reason, raising awareness about this issue is one of its priorities. It offers water safety courses that include training on life jacket use, CPR, and other procedures.

Community-Based Participatory Research

Engaging the community partners in the research process is recognized as an effective approach to improving the safety and wellbeing of specific groups. It helps integrate training with social action. The three community-based participatory research (CBPR) principles that will be used in working with the chosen organization are listed below.

  1. Recognition of the community as the basic relational unit (Isreal et al., 2010).
  2. Building on the strengths and resources in the community
  3. Co-learning and capacity building among partners (Isreal et al., 2010)

Approach and Collaboration

In order to enlist the support of the Harold Mezile North Community YMCA in the development and implementation of the drowning prevention proposal, the organization’s board member, Calvin Allen, will be contacted via a phone call. Our discussion will focus on the costs and impact of the policy and advocacy for drowning prevention through swimming instruction.

The collaboration will be crucial in promoting the feasibility and acceptability of the proposal. I will request to speak during a regular meeting of the members to obtain buy-in and support for the policy. Recruitment of volunteers – representatives of swim instructors, parents, and teens – from the organization to drive the policy change will occur during this engagement. These contacts will be a part of the workgroup of stakeholders that will explore ways to make swimming instruction available to all children in Minnesota. We will hold in-person meetings twice weekly and use an online platform to exchange ideas and documents.

Goal Alignment

Harold Mezile North Community YMCA offers unique programs for children aimed at combating disparities. Thus, it will support an initiative aimed at reducing the risk of drowning in students in public schools with limited access to swimming pools. Its guiding philosophy of ensuring the safety of kids in and around water is aligned with the policy proposal (YMCA Twin Cities, 2020). The organization offers swimming lessons in indoor pools throughout the year. Other activities that are aligned with the policy include instruction on life jacket use, survival skills, and water safety procedures.

Action Steps

  1. Townhall meetings across the state of Minnesota to obtain buy-in and support for the policy proposal.
  2. A social media campaign on Facebook and Twitter dubbed ‘SwimSafe’ initiative – swimming instruction protects children from drowning.
  3. Public service ads on mass media – television and radio.

Roles and Responsibilities

YMCA’s master trainer
  • Keynote speaker in town hall meetings
  • Address resources, equipment, and curriculum changes needed to offer swim lessons
  • Identify community partners with tools that can be used for swimming instruction
YMCA’s current webmaster
  • Give regular updates and resolutions of the town hall meetings to social media users
  • Upload videos and pictures of the meetings
  • Receive feedback and respond to queries posed by users
  • Involvement of influential local personalities to generate traffic to our site
YMCA’s media relations person
  • Responding to queries from the press
  • Writing press releases regarding the workgroup’s work
  • Informing the public about upcoming meetings
  • Highlight the problem of the drowning of children in Minnesota
  • Formation of a community injury-prevention committee to encourage parents to send children to swim classes

The master trainer is an expert in providing swim lessons and water safety classes to children. Given his experience and expertise, he will be the coordinator and keynote speaker during town hall meetings. He will contribute to problem-solving by addressing the challenges of limited resources (swimming pools) and equipment. He will give estimates of the cost of implementing the policy. His contributions to capacity-building efforts will entail identifying community partners with pools and other resources that can be used by schools for swimming instruction.

The organization’s current webmaster will be responsible for updating the public about town hall meeting resolutions. She will also upload videos and pictures to engage users and encourage support for the proposal. The individual will contribute to problem-solving by addressing user queries about the policy and what it intends to achieve. Involving influential local community figures will help generate traffic to the site, contributing to capacity building.

The media relations person’s responsibilities in the workgroup will include answering queries from the press, writing press releases about the policy, and informing the public about upcoming meetings. He will contribute to problem-solving by highlighting the issue of drowning children in Minnesota to provide a business case for a policy change. By facilitating the formation of a community injury-prevention committee, he will contribute to the capacity building during the policy development process.

Key Elements of Evaluation Plan

The first CBPR principle we selected to use is the recognition of the community as a unit of identity. It is based on local partnerships to provide programs tailored to children at risk of drowning (Stempski et al., 2015). Our group will use this principle by collaborating with established community organizations with tools that can be used for swim instruction by schools. This principle applies to the evaluation plan because the success of the policy will depend on providing culturally appropriate training and pools.

The second CBPR principle we selected to use is building on the strengths and resources found in the community. Our group will apply this value in developing age-appropriate learning outcomes for students. Available facilities and personnel, including lifeguards, will be engaged in discussing the policy. This principle applies to the evaluation plan because more people will attend town hall meetings if experts are involved.

The third CBPR principle we selected to use is co-learning and capacity building among partners (Isreal et al., 2010). This tenet will be applied in discussion forums where participants will share their views with the workgroup during in-person meetings or via social media. This principle applies to the evaluation plan because knowledge exchanges will promote buy-in and public support for the policy.

Community/Organization Plan

Different indicators will be used to evaluate the action steps stated in C2c. For the town hall meetings, success will be measured by the number of people attending the sessions and agreeing to support the policy proposal upon its presentation to the decision-maker after a month. They will champion the idea in the community. For the social media campaigns, the number of likes, shares, followers, and retweets achieved within the first month will be used as a measure of success. User traffic to the organization’s website will also be a useful indicator of the proposal’s popularity. For public service ads on mass media, the number of times ads are played on television or radio per day will be used as a measure of success.

Evaluate the Effectiveness of the Two Different Approaches

The choice of either top-down or bottom-up approaches depends on the policy and the context in which it is implemented. Top-down implementation is a clear-cut system with centralized actors and authoritative decisions, while the bottom-up model starts with the target group. This section summarizes the previous three sections and highlights the pros and cons of the two approaches.

Strengths of Each Approach

The main strength of the top-down model is that it features clear goals articulated in a hierarchical system. The chosen decision-maker can give pragmatic policy objectives and manage the implementation of the drowning prevention proposal. Another strength of this prescriptive approach is the availability of resources at the top to execute the policy (Isreal et al., 2010). The Education department can develop teacher training guidance and learning outcomes.

The major strength of the bottom-up approach is that it gives considerable discretion to street-level implementers based on contextual factors. Thus, the policy on drowning prevention will be adapted to local conditions, including available swimming pools and instructors. Another strength of this approach is that goals and activities are executed with a focus on the impacted groups (Isreal et al., 2010). Community interests and consensus-building among stakeholders will be critical in making swimming instruction available to all students in Minnesota.

Challenges of Each Approach

A fundamental weakness of the top-down approach is that it focuses on the role of central actors in policy implementation. However, local players and community experts (school districts) understand the problem more deeply and are better placed to implement the drowning prevention proposals. Another flaw with this approach is that it disregards the political dimension of policy implementation (Isreal et al., 2010). Implementers state clear goals, which may not be practical in obtaining adequate support for the proposal to be passed into law.

The bottom-up approach faces two main criticisms. First, the community-level implementers are often not accountable to the public. Thus, they may subvert the initial policy goals and focus on narrow ambitions. Second, it emphasizes the independence of the local agents. However, legislators have the power to formulate policies since they are the representatives elected by the people.

Most Effective Approach

This paper has considered drowning prevention through swimming instruction in schools. The implementation process of the policy proposal to reduce the high number of drowning incidents may involve a top-down or bottom-up approach. The latter model is recommended as the most effective framework for implementing swimming instruction in all Minnesota schools. It is a realistic approach to garnering the support of the schools, parents, and community organizations and mobilizing resources for drowning prevention.


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