Chapter 31: The Nurse in Schools
school nursing
a specialized practice of professional nursing that advances the well-being, academic success, and lifelong achievement of health students -give comprehensive nursing care to the children and the staff at the school -they coordinate health education programs of the school and consult with school officials to help identify and care for other persons in the community -can give care to those in juvenile detention centers, in preschools, daycare centers, during field trips, sporting events, and in the children's homes -they must be flexible in providing care, education, and help to those who need it
federal legislation (in the 1970s, 1980s, 1990s, and 2000s)
Section 504 of the Rehabilitation Act of 1973 -Part of Public Law -was an important step in helping all children enjoy a normal educational experience -children cannot be excluded from schools because of a handicap; the school must provide health services that each child needs Education for All Handicapped Children Act -required that children with disabilities have services provided for them in schools -all children should attend school in the least restrictive environment; requires school district's committee on the handicapped to develop individualized education plans for children Americans With Disabilities Act (1992) -required more children be allowed to attend schools -persons with disabilities cannot be excluded from activities Individuals With Disabilities Education Act (IDEA) (1997) •Individualized education plans (IEPs) -plans to decide educational accommodations for disabled children (education services must be offered by the schools for all disabled children from birth through the age of 22) -schools had to make allowances for children with special needs, ensuring it that their experience was in balance with their health care needs •Individualized health plans (IHPs) -plans to decide the health needs of disabled children in the school No Child Left Behind Act of 2001 -requires a healthy environment in schools Child Nutrition and WIC Reauthorization Act of 2004 -this was passed to address obesity and to promote healthy eating and physical activity through changes in school environments -designated that each local education agency (LEA) participating in federal school meal programs such as the National School Lunch or Breakfast Program, must establish a local school wellness policy Healthy, Hunger-Free Kids Act of 2010 -authorized funding and set policy for federal school meals and child nutrition programs to increase access to healthy food for low income children
prevention of childhood injuries (primary prevention strategy)
accidents are the leading cause of death in children and teenagers -school nurse educates children, teachers, and parents about prevention -working with the national *Safe Kids Campaign*, the school nurse can provide educational programs reminding kids to use their seatbelts, wear helmets -crossing the street, water safety, fire safety -provide info on prevention of playground injuries by assessing playgrounds for equipment safety -decide hoe to best prevent injuries on a sports field
history of school nursing
began with the earliest efforts of nurses to care for people in the community -Began in the late 1800s in England, the Metropolitan Association of Nursing provided medical examinations for children in the schools of London -1982: nurses in the London were responsible for checking the nutrition of the children in schools -1897: nurses in NYC schools began to identify ill children; they then excluded these children from classes so that other children would not be infected -many states had laws in the late 1800s mandating that within the schools, nurses teach about the abuse of alcohol and narcotics -1902: in NYC, Lilian Wald's Henry Street Settlement nurse began going into the homes and schools to assess children (PHN were only in 4 schools at this point) and made plans to identify those with lice, children with infected wounds, TB, and other infectious diseases -by 1920: school nurse teachers were employed by most municipal health depts -in 1940s: the nurses were employed mostly by the school districts directly -after WWII, and into the 1950s, as a result of increased use of immunizations and antibiotics, the number of children with communicable disease in schools decreased (which shifted what school nurses focused on, no longer communicable disease)
children who are autistic (tertiary prevention in schools)
children with this disease go to regular schools in most cases the school nurse helps the child, teachers, and parents so that they child's school day is pleasant as follows: -the nurse can give the child prescribed medications for mood or prevention of seizures -the nurse is responsible for preparing the teachers for the communication problems the child might have -nurse may recommend the use of sign language, picture boards, or other types of communication devices that are used by the child -can teach the parents about autism nurse can help parents work with others int he health care system so the child can have a positive learning experience at school
substance abuse prevention education (primary prevention strategy)
educating children and adolescents about the effects of alcohol and other drugs on the body -preventing us and promoting saying no to drugs -teenagers are taught by school nurse to stay away from drugs -teaching teens about the dangers of all drugs is the responsibility of the school nurse -nurse can teach parents and community about the latest drug fads, increasing awareness of dangerous trends
direct caregiver (school nurse roles)
expected to give immediate nursing care to the ill or injured child or school staff member -this is the traditional role of the school nurse -in public and private school give care during school hours -boarding schools give care to children 24/7 (nurse also lives at the school and may be on call all the time); nurse is the gatekeeper to complete healthcare as they make decisions for child's health and makes referrals
school based heath centers
family-centered, community based clinics run within schools, often in low income populations -these centers provide primary health care services including mental health and dental are -range in size from small to large -some have a single clinician providing primary care services whereas others have multidisciplinary teams providing comprehensive services -ACA provided funds to improve and expand services here -these programs improve educational outcomes including school performance, grade promotion, and high school competition
roles and functions of school nurses
give care to children as direct caregivers, educators, counselors, and case managers -they must coordinate the health care of many students in their schools with the healthcare that the children receive from their own health care providers and be leaders in schools -having enough adequate school nurse staffing is important; fewer nurses in schools means nurses are expected to perform many different functions (thus unable to provide comprehensive care that students need) -there should be 1 nurse for every 750 students in each school Provide comprehensive nursing care to children and staff at the school. -Coordinate school based health programs activities -Coordinate the individual health care needs of students in collaboration with health care providers and other health care team members Plan, coordinate, and implement nursing interventions for emerging school health issues: -Emergent infections diseases i.e. COVID -Changes in immunization regulations/requirements -Children with special needs including behavioral/mental health disabilities -Adolescent pregnancy -Students with gender based needs LGBTQI -Abuse and neglect (parents, sex trafficking) -Violence via social media, dating violence, bullying, gang violence
case manager (school nurse roles)
helping to coordinate health care for children with complex health problems -may include the child who is disabled or chronically ill, who may be seen by PT, OT, speech therapist and other health care provider during the school day -nurse sets up the schedule for the child's visits so that those appointments don't have a negative effect on the child's academic day
giving medication in school (secondary prevention strategy)
includes -prescribed medication -medications that the parents have asked the school nurse to give (cold remedies) -vitamins nurse should develop a series of guidelines to help with legal administration of medications in the school -parents should be sure to tell school nurse if child is on any medications -prescribed drug should have the original prescription label on it and be in original container so no errors -current, signed parental consent form for giving the medication should be in student's file -current medication drug book should be in the nurse's office so it can be consulted for information nurse should have means of contacting a pharmacist to ask questions regarding medication if needed
secondary prevention in schools
involves caring for the children when they need health care, this is the largest responsibility for the school nurse -includes caring for the ill or injured students and school employees -involves screening, assessing children, and referral to appropriate health agencies or providers -uses nursing process -when ill child comes to the school's health office, the nurse must immediately assess the child for degree of injury or illness -once assessment data are gathered, the nurse determines the course of action and follows it through the implementation and evaluation phase reasons child seeks out school nurse: -headaches -stomach aches -diarrhea -anxiety being separated from parents -cuts, bruises, injuries -place to hide from bullies
children with asthma (tertiary prevention in schools)
leading cause of chronic illness among children and adolescents in the US -one of the leading cause of absenteeism among children with a chronic disease asthma triggers in school -chalk dust from blackboards -mold or mildew in the school -dander from some pets that live in the classroom school nurse can keep track of indoor air quality of the school so that school administrators have data about what can affect the children nurse interventions -administering or helping the children use their inhalers or other asthma rescue medications -teaching the teachers, children, and parents about asthma and ways to reduce the factors to which the child may be allergic in the classroom
health educator (school nurse roles)
may be asked to teach children both individually and in the classroom -different approaches to teach about health -may teach about puberty changes -may teach health education classes that are required by state to be included in programs
emergency equipment in the school nurse office (secondary prevention strategy)
necessary equipment includes: -full oxygen tanks with oxygen masks of different kinds (bag-valve masks, resuscitation masks) -splints for sprained or broken limbs -cervical spine collars to keep child's health in proper alignment -sterile dressings various sizes needed because of children's different ages in the school epinephrine autoinjector kit also recommended -nurse will need to teach other school personnel how to use in emergency gloves should be available for standard precautions telephone should be available to call emergency personnel and parents paper and pen next to phone so that instructions from emergency personnel can be written AED in central location at school for easy access
disease prevention education (primary prevention strategy)
nurse has the opportunity to teach children about healthy lifestyles to reduce their risk for disease alter in life -ex: teaching and reinforcing nutrition and exercise, then the school nurse can reinforce the teacher's educational plans or develop the program further for other age groups to teach them how to take care of their heart
children with special needs in the schools (tertiary prevention in schools)
nurse responsibilities: -to supervise a health aide who is assigned to the child to care for complex nursing needs -to provide tertiary care to maintain the child's health -to maintain the skills needed to assess the child's well-being -to teach another person in the school how to care for the child in case the nurse is not in the building when the child needs help responsibility of the school nurse to keep up with the latest health care information through inservice programs school nurses may care for children with HIV or AIDS as they attend school -school nurse may not even know that a child has HIV or AIDs attends the school -nurse must be aware of the child's HIV status by direct notification from the physician or parens or by knowing certain drugs the child is taking during the day are anti-HIV medications -in all cases, the nurse cannot release information to anyone (if they do know)
nursing care for emergencies in school (secondary prevention in schools)
nurse should have an emergency plan in place so that a routine can be followed when emergencies occurs should include: -an assessment of emergency, surveying the scene -treating the injured -calling for backup help from the community's emergency medical units if needed plans should bed developed in schools in case of an emergency when a child or staff needs immediate care -this should be used by other staff if the nurse happens to not be there nursing plan for special health needs: -HCP orders for 72 hour lockdown or disaster -system for retrieving and transporting medications of areas of lockdown or evacuation -provision of necessary supplies and food in the class room or carried with the child or teacher in an evacuation or a 3 day supply in case of lockdown -education on staff members responsible for the child with special needs during an emergency -an alarm system for students with auditory and/or visual needs -backup power source for specialized equipment -emergency evacuation plan for students with physical, mental or communication limitations school emergency plan: -if nurse not in school at all times, at least 2 different staff members identified as responsible for determining whether emergency care is needed (educated by school nurse on proper first aid so correct care is given until further help arrives) -all staff should be taught standard precautions -members of athletic staff should be up to date on emergency health providers (policies and first aid) -children in schools should be taught basic first aid procedures by the nurse including standard precautions related to blood exposure crisis teams are prepared to help everyone respond quickly to the crisis, to ensure the safety of school, and to follow up on effects of the crisis on members of the school -plan includes names of person on crisis team which includes school nurse -nurse can help the crisis team make a checklist for everyone to follow that explains what do in every possible crisis situation nurse may not always be at school and the emergency, may have to handled by other people -therefore all emergency procedures should be written out or easy to access to anyone in the school an emergency manual should be written or obtained by the school nurse including -an injury or illness log maintained by personnel so emergency is accurately recorded -procedures should be available to notify parent about the emergency, what was done for the child, and where the child was sent nurse needs to have current certification on CPR and use of an AED which is available through AHA -PALS may be helpful as well
community outreach (school nurse roles)
nurses can be involved in the following -community health fairs or festivals in the schools -teaching others an influenza immunization program for the school staff -promoting a health education fair and blood pressure screening program -initiating a liaison -coordinating with local health charities to provide education to the schools
children with DM (tertiary prevention in schools)
one of the most common chronic diseases in children and adolescents -the school nurse must establish a plan of care for children wit this -this includes plans to monitor blood glucose levels and give insulin or other medications during the school day -special nutritional needs may need to be discussed
standards of practice for school nurses
professional body for school nurses if the National Association of School Nurses (NASN) -provides general guidelines and support for all school nurses -standards of practice include: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation -professional performance standards include quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, leadership, program management services provided by school nurse according to NASN: -leadership: development of programs, policies, and procedures for school health series at individual and district level and acts as an advocate for student -community/public health: school nurse provides interventions in each of the levels of prevention, as well as disease surveillance, promoting health equity, and delivering effective cultural competent care to diverse communities -care coordination: school nurse coordinates student health care between the medical home, family, and school -quality improvement: the school nurse utilizes continuous quality improvement in the nursing process and utilizes research data in his or her practice American Academy of Pediatrics (AAP) developed its own ideas about how nurses function in schools based on assessment of schoolchildren's health needs -recognize the important role school nurses play in promoting optimal health and well-being in school-age children in school setting, noting school nurse often leads the coordinate school health program The American Academy of Pediatrics (AAP) guidelines state that school nurses should ensure the following: -That children get the health care they need, including emergency care in the school -That the nurse keeps track of the state-required vaccinations that children have received -That the nurse carries out the required screening of the children based on state law -That children with health problems are able to learn in the classroom
children who have ADHD (tertiary prevention in schools)
school nurse can help these children learn appropriate behaviors to reduce classroom disruptions
consultant (school nurse roles)
school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children -nurse can also recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places
identification of child abuse and neglect (secondary prevention strategy)
school nurse is mandated by law to report suspected cases of child abuse or neglect -should be aware of statement reporting guidelines -a nurse who identifies a child who may be abused or received info from a teacher or staff that leads to the belief that a child was abused, they must contact appropriate legal authorities and the school's principal -confidential file should be made about the incident -nurse should let govt authorities know to look into the suspected case -child should be protected from harm and these who have no right to know that the child abuse or neglect is suspected, should not be given information
communicating with health care providers (secondary prevention strategy)
school nurse makes an assessment of a child that requires referral to child's physician or other HCP -findings must be communicated accurately to child's parent and the provider -nurse must be able to get info quickly and accurately to child's parents -one way to do this is to write down a detailed report about the findings which can be given by telephone that tells them the child needs to see a physician and child will be bringing home info that day
pregnant and teen mothers at school (tertiary prevention in schools)
school nurse may provide ongoing care to mother -tertiary prevention because adolescent pregnancies are considered to be at high risk
primary prevention in schools
school nurse see children on an almost daily basis and is usually the person who is given the role of teaching them about and promoting their health -may have the opportunity to go in the classroom to teach about health promotion concepts (handwashing, or teeth brushing skills) -can give teachers latest information on healthy lifestyle for children or ways to spot children who may be ill or in need of counseling areas focused on by school nurse -preventing childhood injuries -preventing substance abuse behaviors -reducing risk for development of chronic disease -monitoring immunization status all care completed for the population of children in the school -use the nursing process while they care for children in school
required vaccinations for school children (primary prevention strategy)
school nurses must be up to date on the latest laws on immunizations for children in their own state children entering kindergarten they need: -diphtheria -pertussis -tetanus (DPT series) -measles, mumps, rubella (MMR series) -polio school nurse must keep a complete file of all children's vaccine records to meet the state laws -this makes it easy for the school nurse to find out which children still need immunizations or boosters children are prevented from attending school if they have not had the required shots, so the school nurse must make every effort to find missing data in the immunization record -contact parents -written notes sent home once a year before new vaccines are needed -notes translated into family's language -encourage parents to contact physicians to get history nurses should be familiar with state programs that provide fee immunizations to children for those families that have no insurance, moved many times, or those who do not have a regular physician nurse may talk to to parents about the importance of vaccines to protect all school children for parents who request their child be exempt due to religious, medical, or philosophical reasons -provide EBP literature -decision is up to the parents and should be respected -then up to school administration to determine admission of the child
screening children for lice (secondary prevention strategy)
school nurses must screen children for ___________ infestation -most commonly found in those 3 to 11 years old -much less common among african amercians -getting head lice is not related to cleanliness of person or home, rather they are spread through direct contact with hair of infested person (head to head contact) -school nurse needs to check because those who have are excluded from school -during the check, the nurse must check children's hair for lice and nits responsibilities of school nurse: -accurate health education to school communtiy about etiology, transmission, assessment, and treatment -advocate for school policy that is more caring and less exclusionary (elimination of no nit school policies) -implement intervention strategies that are student centered -support the current treatment recommendation of the AAP and CDC -participate in research that evaluates effectiveness of head lice policies and educational programs
assessing and screening children at school (secondary prevention strategy)
should receive screening for vision, hearing, height and weight, oral health, TB, and scoliosis in schools -school nurse should keep a confidential record of all screening results for children in school according to HIPAA rules -physical examinations to play in school sport may also be given in the school
homebound children (tertiary prevention in schools)
some children cannot go to school, instead they are taught in the home or another institutional setting such as the hospital school nurse function: -should be a liaison between the child's teacher, physician, school administrator, and parents regarding the child's needs -help individuals make up the child's IEP so that it is appropriate for the child and does not remove necessary learning from the plan -allows the child to go to school when he or she is able -coordinates the child's healthcare needs and classes
tertiary prevention in schools
this is done when working with children who have long-term or chronic illnesses or children with special needs -nurse participates in developing an IEP for students with long term health needs nurse responsibilities -info about child's medications to be given during school hours -must know if the child needs therapy during school -must know if the child has hearing or vision problems -nurse must ask the teacher to seat the child in the best place in the classroom so the child can better see or hear the teacher or other children school nurses responsibility to tell the school administrators about any needs such as alterations of building so the child can get around and use the restrooms
efforts to prevent suicide and other mental health problems (secondary prevention strategy)
suicide is the second leading cause of death in adolescents 15 to 19 -a suicide prevention program contains ideas for the school nurse to use suicide prevention must be addressed by the school nurse who can do: -lead education programs to emphasize coping strategies and stress management techniques and to teach about risk factors -teach faculty members to look for risk factors -help organize a peer assistance program to help teenagers deal with stress if student threatens suicide at school, the school nurse should intervene by ensuring safety of the student and removing him or her from the school situation immediately -while parents are notified, school nurse should assess the child's suicide risk and refer to the child or teenager to crisis intervention or mental health services if a child does commit suicide, the nurse may be called on to help the school population, both teachers and students, cope with death -grief counseling should be set up and coordinated by the school nurse -assessments should be made regarding suicide potential of deceased teen's friends school nurse plays a vital role in assessment, identification, intervention, referral, and follow-up of students in need of mental health services and serves as advocates, facilitators, and counselors of mental health services school nurse can be an advocate for homeless children
school health and policies programs study
the national survey that assess school health policies and practices at the state, district, school, and classroom levels -survey assess the characteristics of the Whole School, Whole Community, Whole Child model
children with DNR orders and the school nurse (tertiary prevention in schools)
the school nurse also maintains the health of children with terminal diseases who go to school -children have been mainstreamed into regular school population -children who have this order may attend the school and some may die at school -under law, school nurses are bound to obey the DNR order, however it is not clear how the school views them -recommended those with a DNR have an IHP and emergency care plan (ECP) developed by the school nurse with input from parents, the local funeral director, and when appropriate, the student -when a child dies in school, the nurses is responsible for helping the children who witnessed the death -the nurse becomes a grief counselor and helps the children and teacher cope with death -further education about death and dying given by the school nurse would also help the school community cope with death in the school
researcher (school nurse roles)
the school nurse as an educator is the right position that advances school nursing practice -school nurse is responsible for making sure that the nursing care given is based on solid, EBP -outcomes regarding school nurse services need to be studied
counselor (school nurse roles)
the school nurse is considered a trustworthy person to whom the children can go if they are in trouble of if they need to talk -nurses in this situation should tell children that if anything they reveal indicates that they are in danger, the parents and school officials must be told -privacy and confidentiality is important though -school nurse may be the person to help with grief counseling in schols
violence in school (secondary prevention strategy)
the school nurse may identify students who will act in a violent way such as with school shootings -nurse can provide health education classes to help children learn positive ways of dealing with conflict students may come to school nurse complaining of psychosomatic illnesses such as headaches and stomachaches due to bullying -school nurse needs to be knowledgeable about bullying and provide leadership to implement bullying prevention strategies such as increased supervision and antibullying policies school nurse's primary goal is to prevent violence from occurring and prioritize safety of everyone on the school's campus -by helping identify the student who might be considering school violence and by teaching students and teachers about these warning signs in students, the school nurse may be able to help prevent violent actions through education and follow-up of children who need help
children with allergies (tertiary prevention in schools)
the school nurse must take leadership role in coordinated care for these students -the school nurse must develop a plan for preventing exposure to a known allergen and responding to an allergy emergency, collaborating with the student, the student's parents, and school personnel to determine the best plan of action -school nurse must provide training to school personnel who are involved with the student -most states have laws allowing students to carry emergency medication and if developmentally appropriate, self administer as needed
levels of prevention in schools
the three levels of prevention have always been a part of health care in schools primary prevention -provides health promotion and education to prevent health problems in children secondary prevention -includes the screening of children for various illness, monitoring their growth and development, and caring for them when they are ill or injured tertiary prevention -continued care of children who need long term health care services along with education in the community
