Chapter 22: School Health Nursing
Individuals with Disabilities Education Act (IDEA)
Federal law enacted in 1990 and reauthorized in 1997, designed to protect the rights of students with disabilities by ensuring that everyone receives a free, appropriate public education, regardless of ability. IDEA strives to grant equal access to students with disabilities and to provide additional special education services and procedural safeguards. Individual Education Plan (IEP), or 504 Plan, is developed by an interdisciplinary team to provide education and services to any student that has an identified disability to correspond with individual needs in the least restrictive environment. The school nurse is an integral member of an IEP.
How do you establish a relationship with an insulin-dependent diabetic 12-year-old, who developmentally should be starting to rebel?
Find creative ways to give the child the care they need. Ex: Reward system, control, get parents involved.
Is the following statement true or false? Early Periodic Screening, Diagnosis, and Treatment (EPSDT) is a program mandated by a federal law passed in 1969, which required that children and adolescents younger than 21 years of age have access to periodic screenings.
True Rationale: Early Periodic Screening, Diagnosis, and Treatment (EPSDT)—program mandated by a federal law passed in 1969, which required that children and adolescents younger than 21 years of age have access to periodic screenings. EPSDT recognized that schools are the place to identify children with problems, increase student's access to preventive and curative services, and ensure appropriate use of health resources for children on Medicaid.
WSCC Model
Whole School, Whole Community, Whole Child (WSCC) Model Health education, alone, has minimal effect on common health problems. WSCC is a comprehensive design that links the community and the school. It is the future of school nursing and a prevention framework. WSCC uses the resources of a community to provide structured preventive services such as after‐school programs, parent outreach, and crisis intervention.
School Nurse Health Assessment of the Individual and Population
-Acute illness (vomiting, fever, headache, injury, acute allergy) -Screenings (vision/ hearing, scoliosis, BMI, immunizations) -Counseling (students seek advice and support) Due to state requirements, school nurses tend to be extremely busy during the beginning of the school year.
Common Health Concerns in the School
-Drugs and alcohol -Smoking/ vaping -Sexual behavior and teenage pregnancy -Sexually transmitted infections -Nutrition Violence/ Abuse -Especially at the high school level.
How difficult would it be to regularly straight-cath a child with chronic urinary dysfunction while maintaining sterility and privacy at school?
-For kids w/ chronic issues meeting with the parents prior to the beginning is important to make a plan.
School Health Nursing
-Role of the school nurse has evolved over time in response to the increasing number of complex health issues seen at school. -School Nursing is a specialized practice of professional nursing that advances the well‐being, academic success, and lifelong achievement of students.
Best Practices: Prevention of Tobacco Use
1.Develop and enforce a school policy on tobacco use. 2.Provide instruction on short- and long-term negative consequences of tobacco use, social influences, peer norms, and refusal skills. 3.Educate in K-12th grades. Should be intensive in junior high and reinforced in high school. 4.Train teachers and involved parents and families. 5.Support cessation efforts among students and school staff who use tobacco. 6.Assess the tobacco-use prevention program.
Lillian Wald and School Nursing
1902: Lillian Wald started school nurses in NYC to decrease absenteeism. Nurses mainly treated minor contagious diseases, taught health education programs, and made home visits to educate families. Since the passage of the Education for All Handicapped Children Act of 1975, school nurses have provided more complex care for several conditions. Children who had been unable to attend school because of chronic or complex medical issues were now entitled to a public education. For example, children with seizure disorders, asthma, cardiac conditions, cystic fibrosis, quadriplegia, and life-threatening allergies. Today: not unusual for school nurses to see up to 100 visits per day
What is the average # of students a school nurse may see in the week with similar complaints of GI sxs?
As the school nurse, you see 50 kids a week that walk into your office complaining of abdominal pain. How to differentiate among those that need to go home or those that can stay in school? Sxs could point to: -Could this be early appendicitis? -Constipation? -Viral infection? -GI upset from lunch? -Or the kid that just want to go home?
Other school nurse things to be on the look out for:
Can you differentiate between active lice infection and dandruff /dry scalp? Teaching parents how to take care of it. Even though it's rarely needed, a school nurse needs to be proficient at recognizing & treating anaphylaxis, alcohol and drug overdoses, cardiac arrest, airway obstruction, active bleeding, and traumatic brain injury. - Rarely used but as a nurse you have to learn to recognize these things. School nurses are also in the perfect position to recognize abuse.
Youth Risk Behavior Surveillance Survey (YRBSS)
Data from the YRBSS, a biannual report of the common risk behaviors influencing the health of our nation's youth, can be used by the school nurse as a tool for monitoring trends both locally and nationally. Risk Behavior Categories: -Behaviors that contribute to unintentional injuries & violence. -Sexual behaviors related to pregnancy, STIs, and HIV infection. -Alcohol and other drug use. -Tobacco use -Unhealthy dietary behaviors. -Inadequate physical activity.
Role of the School Nurse Con't
Health promotion -School Health Index collection tool School health needs Health educator Emergency preparedness School Emergency Triage Training (SETT) -Disaster preparation training. Chronic Absenteeism is an evidenced-based indicator of children at risk, not just of academic failure, but other social, emotional, or physical health concerns and health inequities.
The School Nurse as a Child Advocate
Provide education and communication necessary to ensure that the student's health and educational needs are met. Implement strategies to reduce disruptions in the student's school activities. Communicate with families and healthcare providers as authorized. Ensure the student receives prescribed medications and treatments and that staff who interact with the student on a regular basis are knowledgeable about these needs. Provide a safe and healthy school environment to promote learning.
Role of the School Nurse
School nurses provide a critical link between the child, the family, and the education and healthcare system. Each state has its own nurse practice act that regulates the profession, including school nursing. National Association of School Nurses (NASN) and American Nurses Association defines the practice of school nurses.
Impact of COVID-19 on absenteeism in schools
School nurses were assisting with deliveries to students such as medication and food. Students with disabilities and special needs were often at a greater disadvantage. Schools represent one of the greatest opportunities to communicate important health messages to America's children and youth. School nursing is a specialized practice of nursing that protects and promotes student health, facilitates optimal development, and advances academic success.
Clinical Practice Guidelines
Systematically developed statements to assist practitioner and patient decisions about appropriate health care practices for specific clinical circumstances. Ex: Epilepsy. Nurse has to ensure than a care plan is available and preparations are made towards how to handle specific scenarios.
Americans with Disabilities Act (ADA)
Wide‐ranging federal legislation enacted in 1990 that is intended to make American society more accessible to people with disabilities. Made it illegal to discriminate against students/ children with disabilities anywhere in any institution.
