Ch 31 The Nurse in the schools
A middle school student approaches the school nurse and asks, "Can I speak with you about something important?" The school nurse responds affirmatively but should also state which of the following?
"If anything you tell me indicates that someone is in danger, the parents and school officials must be told." The school nurse may be the person whom children trust to tell important secrets about their health. The school nurse has a reputation as being a trustworthy person to whom the children can go if they are in trouble or when they need to talk to someone. Nurses in this situation should tell the children that if anything they reveal points out that someone is in danger, the parents and school officials must be told.
A unique characteristic of the standards of practice for school nurses is which of the following?
Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students. In general, the National Association of School Nurses (NASN) standards align with those developed by the American Academy of Pediatrics (AAP) regarding giving health care to students in the schools. The AAP developed its own ideas about how nurses function in schools based on its assessment of school children's health needs. These guidelines are very similar to those written by the NASN. Additionally, the AAP recommends that the nurse be the head of a health care team that includes a physician (preferably a pediatrician), school counselors, the school psychologist, and members of the school staff including the administrators and teachers.
A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological, and social services as components of the student health services. Additionally, the district has integrated family/community involvement, staff health promotion, and a commitment to a healthy school environment in its program design. This school district has adopted the school health service program scope of which of the following?
CDC's Federal School Health Program. The federal government, through the coordination of the CDC, has developed the Federal School Health Program. The plan includes eight parts: health education; physical education; health services; nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family/community involvement.
A second-grade child with cerebral palsy receives services from a physical therapist and occupational therapist during the child's academic day. The school nurse sets up the schedule to ensure that the therapists' visits do not unnecessarily affect the child's academic day negatively. This role of the school nurse is best described as which of the following?
Case manager The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. This may include the child who is disabled or chronically ill, who may be seen by a physical therapist, an occupational therapist, a speech therapist, or another health care provider during the school day. The nurse sets up the schedule for the child's visits so that those appointments do not unnecessarily have a negative effect on the child's academic day. Direct caregiver is the traditional role of the school nurse where immediate nursing care is provided. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse as counselor occurs when children go to the nurse to share important health information.
The school nurse at the intermediate level arranges for a presentation by the trauma educator at the local regional medical center. Bicycle and helmet safety will be the primary topic at the school's open house. This is an example of which of the following school nurse roles?
Community outreach When participating in community outreach, nurses can be involved in community health fairs, reaching others about influenza immunization programs, promoting health education fairs, and coordinating with local charities to provide education to the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. The school nurse as counselor is available to students who need to discuss confidential health matters.
Secondary prevention activities are the largest responsibility of the school nurse and may include which of the following?
Establishing an emergency plan when a child or staff member needs immediate care. Giving medications to children during the school day. Screening for vision, hearing, height and weight, oral health, TB, and scoliosis. Teaching standard precautions to all staff Secondary prevention involves caring for children when they need care and is the largest responsibility of the school nurse. It may include such activities as caring for ill or injured children or staff (including the development of an emergency plan and appropriate training of staff in standard precautions, first aid, and relevant emergency procedures); screening and assessing children; making appropriate referrals; giving medications; identifying abuse and neglect; communicating with health care providers; preventing suicide and violence; and responding to disasters.
A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school. A tertiary prevention intervention the school nurse should perform would be which of the following?
Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience. The school nurse gives nursing care related to tertiary prevention when working with children who have long-term or chronic illnesses or with special needs. This may include participation in the development of an individual education plan (IEP); identification of medication, therapy needs, and/or physical, auditory, or visual limitations; and interventions to ensure the appropriate placement of the child in the classroom environment or physical accommodations required, which enhances the child's learning experience.
At the end of each school term, the school nurse schedules an equipment safety assessment of each school playground in the district. The school nurse uses the guidelines of the U.S. Consumer Protection Safety Commission and prepares a report of the findings for the school board for planning purposes. This intervention by the school nurse is an example of which of the following?
Primary prevention Injuries are the leading cause of death in children and teenagers. The school nurse educates children, teachers, and parents about preventing injuries. School nurses also provide information on how to prevent playground injuries. They assess school playgrounds for equipment safety on the basis of the U.S. Consumer Product Safety Commission guidelines.
The future of school nursing is very strong and will be further enhanced by the future trend in which of the following?
Telehealth and telecounseling The amount of health care being given in the schools is increasing. In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. The school nurse is responsible for keeping up with the latest changes in health care and health practice so that the health of children in the schools can be enhanced by new trends in health care.
An urban school-based clinic is located in a school district where many of the children lack health insurance. The school nurse continues to provide screening, assessment, first aid, and record keeping but can refer students who require additional services to the nurse practitioners that staff the school-based health center (SBHC) on the school grounds. The SBHC is federally funded under which of the following?
The Affordable Care Act School-based health centers are family-centered, community-based clinics run within schools under a federally funded program. These clinics give expanded health services, including mental health and dental care, in addition to the more traditional health care services. The Affordable Care Act of 2010 appropriated $200 million to improve and expand services at SBHC. They can vary in size, hours, and days of operation, or administrative model (i.e., school clinic, health center, school-linked program). They are successful because they focus on bringing health care services to children in a community school location and are coordinated with the school health program
