Pop ch 31

Children with asthma

*tertiary prevention* Asthma is the leading chronic illness among children and teens Children may be hospitalized with an asthma attack, or they may have just returned home from the hospital; asthma can also be caused by allergic triggers such as chalk dust, molds, mildews, dander from pets, air quality The school nurse can keep track of the indoor air quality of the school so that school admin have data about what can affect the children Schools nurses can administer or help children use their inhalers or other asthma rescue meds, teaching the teachers, children, and parents about asthma and ways to reduce the factors to which the child may b allergic in the classroom

Pregnant teens and teen moms at school

*tertiary prevention* School nurse may provide ongoing care to the mother Considered to be high risk

Child with diabetes

*tertiary prevention* The school nurse must establish a plan of care for children with diabetes This includes plans to monitor BG and given insulin or other meds during the school day Special nutritional needs also must be discussed

Controversies in school nursing

-birth control education -giving birth control to students in the schools -opinions related to sex education and reproductive services The school nurse should make an effort to communicate with the community, school board, teachers, parents, and students about what they think about different types of services in the school

American academy of pediatrics (AAP)

Developed its own ideas about how nurses function in schools based on its assessment of schoolchildren's health needs

Home bound children and school nurse's role

*tertiary prevention* School nurse should be a liaison between the child's teacher, physician, school admin, and parents regarding the child's needs School nurse must also help these 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 available Coordinates the child's health care needs and classes

Children who are autistic

*tertiary prevention* The school nurse helps the child, the teachers, and the parents so that the child's school day is pleasant This includes: the nurse can give the child prescribed meds for mood or prevention of seizures; the nurse is responsible for prep the teachers for the communication problem that the child may have; the nurse may recommend the use of sign language, picture boards, or other types of communication devices that are used by the child; the nurse can teach the parents about autism The nurse can help parents work with others in the health care system so the child can have a positive learning experience at school

School nursing

As "a specialized of professional nursing that advances the well-being, academic success and lifelong achievement of health of students"

The Promise Neighborhoods program

2010 Seeks to break the cycle of inter generational poverty in the nation's most distressed communities by creating comprehensive, wrap-around education support services and strong, vibrant school environments

Coordinated School Health Program (CSHP)

A comprehensive program with eight interactive components designed to promote optimal health in children and their physical and social environments. Coordinated by the CDC

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

Who started school nursing?

Lillian Wald's Henry street settlement nurses began going into homes and schools to assess children Public health nurses were in only 4 schools, caring for about 10,000 children Made plans to identify children with lice and other infestations and children with infected wounds, TB, and other infectious diseases

PL 93-112 Section 504 of the Rehabilitation Act (1973)

Was an important step in helping all children enjoy a normal educational experience

What important does the school nurse serve?

Providing health services and health promo in the school setting Give comprehensive nursing care to the children and the staff at the school Coordinate the health education program of the school and consult with school officials to help identify and care for other persons in the community Gives care to the children not only in the school building itself but also in other settings in which there are children Must be flexible in providing nursing care, education, and help to those who need it

How to prevent childhood injuries?

*primary prevention* Accidents are the leading cause of death in children and teens The school nurse educates children, teachers, and parents about preventing injuries Work with the Safe kids campaign to provide educational programs reminding children to use their seat belts, bicycle helmets, teaching on how to cross the street, water safety, and fire safety Also provide info on how to prevent playground injuries: assess school playgrounds for equipment safety Promote bicycle, skateboard, and scooter safety by providing health educational workshops to children and their families Be safe during school supports (work along parents and coaches to prevent injuries)

How to promote vaccinations for schoolchildren ?

*primary prevention* All state have laws that require that children receive immunizations, or vaccinations, against communicable diseases before they attend school School nurses must be up to date on the latest laws on immunizations for children in their own state Kindergarten: DPT series, measles, mumps, and rubella, and polio is required Must keep a complete file of all the children's vaccination records to meet the state's laws Bc children are prevented from attending school if they have not had the required shots, the school nurse must make every effort to find missing data in the immunization record (the nurse must contact the parents to get the immunization hx for the child and if they lost it encourage them to call the DR to get access of those record) Certain low-income families without health care insurance may qualify for federal programs that provide free immunizations to children Must speak with parents about the importance of immunizations to protect all schoolchildren (provide EBP literature to help parents make decisions)

How to educate and prevent substance abuse prevention ?

*primary prevention* Educating children and teens about the effects of alcohol and other drugs on their bodies Preventing use of and promoting "saying no" to drugs have been part of the school health program for years Teens are taught by the school to stay away from drugs and alcohol Teaching teens about the dangers about club drugs, is the responsibility of the school nurse Increase awareness of these dangerous trends

How to educate about disease prevention ?

*primary prevention* Nurse has the opportunity to teach children healthy lifestyles to reduce their risk for disease later in life Reduce risk of becoming obese and reinforcing healthy nutrition and exercise School nurse can then reinforce the teachers' education plans or develop the program further for other age groups to teach them how to take care of their heart Nurses shares important health info related to school age children on subjects such as immunization requirements, flu prevention tips, and school health policies, procedures, and plans (website or online)

Assessing and screening children at school

*secondary prevention* Children should receive screening for vision, hearing, height and weight, oral health, TB, and scoliosis in the schools Keep a confidential record of all screenings Physical exams to play in a School sport may also be given in the school The school nurse would arrange for the sports physical and would help monitor the examinations being done by the schools MD or NP Screen for TB (can be an issue for reading the results 3 days later due to being part time) = contact child's parents to contact MD or NP to read results, ask for report, etc.

Identification of child abuse or neglect

*secondary prevention* Mandated by state laws to report suspected cases of child abuse or neglect Must contact appropriate legal authorities and school's principal A confidential file should be made about the incident Child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given info

Nursing care for emergencies in the school

*secondary prevention* Must have an emergency plan in place so that a routine can be followed when emergencies occur to a child or employee(making an assessment of the emergency and surveying the scene, treating the injured or ill children or teachers, calling for backup help from the community's emergency medical units if needed) Must also have a crisis plan in place to help the children, teachers, parents, and the community cope with the student event The crisis plan includes an administrative policy made either for the nature school district or if the schools are large for each individual school The plan includes the names of the persons on the crisis team The nurse can help crisis team make a checklist foro everyone to follow that explains what to do in every possible crisis situation Should be reviewed every year Nurse may not always be at the school, so it needs to be accessible for teachers, administrators, secretaries, custodians, or coaches Nurse must have certification of CPR and use of AED

Emergency equipment in the school nurse's office

*secondary prevention* Necessary equipment includes: full oxygen tanks with oxygen masks of different kinds, splints for sprained or broken limbs, cervical spine collars to keep a child's head in proper alignment, and sterile dressings, epi pen (school nurse must teach school personnel on how to use the epipen autoinjector in an emergency) Various sizes are needed due to different ages and sizes A telephone should be available for calling emergency personnel and parents AED should be located in a central location at the school for easy access in an emergency

Communicating with HCP

*secondary prevention* Often makes an assessment of a child that requires referral to the child's family physician or other HCP Communicated accurately to the child;s parent and the provider The nurse must be able to get the info quickly and accurately to the child's parents Be aware of HIPAA privacy rules Write a detailed report about the findings and can be given to child's parents Telephone parents telling them that the child needs to see MD or NP and that the child will be bringing the info home that day so the parents can ask the child and child is aware that the parents expect it

Giving medications in school

*secondary prevention* School nurse may be responsible for giving medications to children during the school day Includes: prescribed meds, medications that they parents have asked the school's nurse to give (cold remedies), and vitamins Nurses should develop a series of guidelines to help with the legal administration of medications in the school Parents should be sure to tell the school nurse if the child is on any medications Prescribed drug should have the original prescription label on it and be in the original container so that there are no errors and a current signed parenteral consent form for giving the medication should also be in the student's file, and a current drug book

Screening children for lice

*secondary prevention* Screen for lice infestation Getting head lice is not related to the cleanliness of the person or his or her environment Lice are spread thru direct contact with the hair of an infested person (head to head contact) Needs it check children for lice bc children with lice are excluded from school During the lice check, the nurse must check the children's hair for both lice and nits Nurses must provide accurate health education to the school community about the etiology and transmission and tx of head lice and the assessment; implement intervention strategies that are student centered, and support the current tx recommendations of the AAP and the CDC

Efforts to prevent suicide and other mental health porblems

*secondary prevention* Suicide is prevalent in teens (15-19) Suicide prevention program and contains ideas for the school nurse to use: -Lead educational programs within schools to emphasize coping strategies and stress management techniques for children and teens who have problems and to teach about the risk factos -Teach faculty members to look for their risk factors -Help organize a peer assistance program to help teens cope with school stress If a student threatens suicide at school, the school nurse should intervene by ensuring the safety of the student and by removing him or her from the school situation immediately Assess the child's suicide risk and refer the child or teen to crisis intervention or mental health services If teen commits suicide, nurse is called to cope with death among the population = grief counseling Students with other mental problems may have early signs. Nurse splay a vital role in the assessment, identification, intervention, referral, and follow-up of students in need of mental health services and serve as advocates, facilitators, and need counselors of mental health services Children who are homeless or have parents with substance abuse: may develop emotional or mental problems and nurses must advocate

Violence at school

*secondary prevention* The school nurse may be able to help identify students who will act in this way nurse can provide health education classes to help children learn positive ways of dealing with conflict *bullying or cyberbullying* Students may comes to the school nurse complaining of psychosomatic illnesses, such as HA, stomach aches, due to bullying; students may feel hopeless and sad and begin to consider to harm themselves The school nurse needs to be knowledgeable about bullying and provide leadership to implement bullying prevention strategies such as increased supervision and antibullying policies Primary goal: is to prevent violence from occurring and prioritize the safety of everyone on the school's campus

Children with HIV

*tertiary care* May also attend school and school nurse may not know the status The nurse may be aware of the child's HIV status either by direct notification from the parents or physician or just by knowing that certain drugs the child is taking during the school day are anti-HIV meds Nurse cannot release that info to anyone Schoo nurse can provide education to the children about HIV/AIDS prevention and risks; can be apart of the school health advisory committee to develop an HIV/AIDS health curriculum that teaches not only about HIV/AIDS prevention but also about the disease itself so that children and families are not afraid to go to school with children who have the disease

Children with allergies

*tertiary prevention* Foo and insect sting allergies that produce anaphylaxis (ex. Milk, eggs, fish, shellfish, wheat , soy, peanuts, and tree nuts The school nurse must develop a plan for preventing exposure to a known allergen and responding to an allergy emergency, collab with the student, the student's parents, and school personnel to determine the best plan of action The school nurse must provide an annual training to school personnel who are involved with the student

Children with DNR and the school nurse

*tertiary prevention* The school nurse also maintains the health of children with terminal diseases who go to school Children with a DNR may go to school and some may die at school Orders are signed by the parents and the DR according to the state of law Under law, the school nurse is bound to obey the DNR order; however it is not clear how the schools view them Each student with a DNR order have an IHP and an emergency care plan developed by the school nurse with input from parents or guardians, the local funeral director, and when appropriate, the student When a child dies in school, the nurse is responsible for helping the children who witnessed the death Becomes a grief counselor Educator on grief and dying

Children who have ADHD

*tertiary prevention* The school nurse can help here children learn appropriate behaviors to reduce classroom disruptions

Children with special needs in the schools

*tertiary prevention* There may be students who need urinary cath, dressing changes, peripheral or central line maintenance, tracheotomy suctioning, gastronomy or other tubes School 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

Nursing plan for children with special health needs in case of an emergency

-HCP orders for 72 hour lockdown or disaster -a system for retrieving and transporting medications to areas of lockdown or evacuation -provision of necessary supplies and food in the classroom or carried with the child or teacher in an evacuation or a 3 day supply in case of a lockdown -education of all staff members/substitutes responsible for the child with a special health 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 communicaiton, limitations

What ethical issues may the school nurse encounter?

-a child may have a DNR order that the parents wish to be used if the child dies at school, but following the DNR order may be against the nurse's personal belief -perhaps a girl asks the nurse where she can get an abortion and wishes to talk to the school nurse about how she feels, but the nurse is against abortion -a teen asks for emergency contraception, which the nurse does not wish to give

Secondary preventions in schools

-caring for ill or injured students and school employees -involves screening and assessing children and referral to appropriate health agencies or providers -use nursing process -immediately assess the child for the degree of illness or injury (HA, stomachaches, diarrhea, anxiety, cuts, bruises, or other injuries) -assess for bullying or harassment -care and screen child !!

What should a school nurse do if violence occurs

-coordinate emergency response until rescue team arrives -provide nursing care for injured students -apply crisis interventions strategies that help de-escalate a crisis situation an help resolve the conflict -identify and refer those students who require more in depth counseling services -participate in risks intervention teams

Interventions that the nurse can implement to prevent violence

-facilitate student connectedness to the school community -engage parents in school activities that promote connections with their children, and foster communication, problem solving, limit setting, and monitoring of children -support activities and strategies to help establish a climate that promotes and practices respect for others and for the property of others -support policies of zero tolerance for weapons n school property, including school buses -advocate for adult monitoring in the hallways between classes and at the beginning and end of the school day, and the assignment of staff to monitor the playground, cafeteria, and school entrances before and after school -serve as a positive role model -educate students and their parents about gun safety

According to the NASN, what are roles of a school nurse?

-leadership: the school nurse leads the development of policies, programs, and procedures for school health series at both an individual and district level and acts as an advocate for the individual student -community/public health: the 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: the 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 practice

Primary prevention in schools

-teaching and promoting health so that way children continue health services in school -may have the opportunity to go into the classroom to teach health promotion concepts, such as hand-washing or tooth-brushing skills or spend time with teachers giving them the latest info on healthy lifestyles for children or ways to spot a child who may be ill or in need of counseling -preventing: childhood injuries, substance abuse behaviors, reducing the risk for the development of chronic diseases, and monitoring the immunization status of children -assess children and families to determine their level of knowledge about health issues -find out whether children are at risk for preventable problems -analyze the assessment findings -implement these activities -evaluate and revise the plan

Tertiary prevention in schools

-when nurses work with children who have long-term or chronic illnesses or children with special needs -the nurse participates in developing an IEP for students with long-term health needs -responsibilities: the nurse must have info about the child's meds to be given during school hours; the nurse must know if the child needs any therapy during the school day; the nurse must if the chil has a hearing or vision problem; the 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 and other children -school building must be altered so child can get around the school and use the restrooms (wheelchairs or use crutches or hearing or vision problems)

General guidelines for school emergency plans include

-when to call 911 for local emergency personnel -how to make arrangements to transfer a child to the hospital via ambulance in case more care is needed -if the nurse is not in the school at all times, at least 2 diff staff members identifies as responsible for determining whether emergency care is needed -all staffing in the schools should be taught standard precautions (should be written in the emergency plan) -members of the athletic staff should also be up to date on emergency health procedures -the children in the schools should be taught basic first aid procedures by the nurse, including standard precautions related to blood exposure

What are the different roles that a school nurse has?

Direct caregiver: traditional role of the school nurse; expected to give immediate nursing care to the ill or injured child or school staff member; boarding school has 24/7 service Health educator: may be asked to teach children both individually and in the classroom; the nurse uses different approaches to teach about health, such as instruction concerning proper nutrition or safety info 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 HCP during the school day Consultant: the school nurse can provide professional info about proposed changes in the school environment and their effect on the health of the children; can also recommend changes in the school's policies or as community organizations to help make the children;s schools healthier places Counselor: nurse is considered a trustworthy person to whom the children can go if they are in trouble or when 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. Community outreach: community health fairs, teaching outs about flu vaccines, promoting a health education fair and a BP screening program, and coordinating with local health charities to provide education to the schools Researcher: responsible for making sure that the nursing care given is based on solid, EBP

PL 105-17 individuals with disabilities education act (IDEA)

Required that more children be allowed to attend schools Schools had to make allowances foe children's special needs, which including ensuring that their school experience was in balance with their health care needs

What actions should the school nurse taken when ethical issues are encountered?

The nurse must give nursing care to the student client and keep personal beliefs out of the discussion If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help The student should be referred to other HCP who can give the care the student needs

PL 94-142 Education for all Handicapped Children Act

Which required that children with disabilities have services provided for them in schools

School Health Policies and Programs Study (SHPPS)

a national survey periodically conducted to assess school health policies and practices at the state, district, school, and classroom levels.

School-based health centers (SBHCs)

federal program providing health care, dental care, and mental health care to children and families in schools. (Pre k to 12th grade) Often for low income can range in size from small to large There are school clinics open to the community only during the school year and also health centers that are open 24 hours per day all day Some have a single clinician providing primary care service, whereas others have multidisciplinary teams providing comprehensive services Improved educational outcomes, including school performance, grade promotions, and high school completion

National association of school nurses (NASN)

professional organization for school nurses that sets standards and guidelines for them Standards include: assessment, dx, outcomes identification, planning, implementation, and evaluation