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Chapter 42

The Nurse in the Schools

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Objectives

1. Discuss professional standards expected of school nurses.

2. Differentiate between the many roles and functions of school nurses.

3. Describe the different variations of school health services and coordinated school health programs.

4. Analyze the nursing care given in schools in terms of the primary, secondary, and tertiary levels of prevention.

5. Anticipate future trends in school nursing.

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History of School Nursing

Late 1800s: Metropolitan Association of Nursing provided medical examinations for children in London schools

1897: New York City schools began to identify ill children Excluded ill children from class so classmate not

infected Health education

1902: Henry Street Settlement nurses began going into homes and schools to assess children.

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History of School Nursing, Cont’d

1910: Teachers College in New York City added course on school nursing

1949s: Nurses employed by the school districts

1950s: Increased use of immunizations and antibiotics

1960s: Call for high levels of education for school nurses ANA position paper

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Federal Legislation

Section 504 of the Rehabilitation Act of 1973 Education for All Handicapped Children Act Americans with Disabilities Act (1992) Individuals with Disabilities Education Act

(IDEA) (1997) Individualized education plans (IEPs) Individualized health plans (IHPs)

No Child Left Behind Act of 2001 Child Nutrition and WIC Reauthorization Act

of 2004

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Standards of Practice

National Association of School Nurses (NASN) NASN Standards (Box 42-1)

American Academy of Pediatrics (AAP) AAP Guidelines (2008)

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Educational Credentials

NASN and AAP recommend school nurses be RNs who also have bachelor’s degrees in nursing and a special certification in school nursing. Not all school nurses have been educated this

way.• Varies from state to state

APNs in schools

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Roles and Functions of School Nurses

Direct caregivers Educators Counselors Consultants Case managers Community outreach Researcher

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School Health Services

Federal School Health ProgramsSchool Health Policies and Program Study 2006

School-Based Health Programs

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Federal School Health Programs:Eight Components of a Coordinated

School Health Program

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School Health Policies and Program Study 2006

Student-to-school nurse ratio Recommended 1 nurse for every 750 students

Access to mental health counselors Schools’ cafeteria

Tended to have food high in salt and fat Parental involvement

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School-Based Health Programs

School-based health centers Family-centered, community-based clinics run

within the schools School-linked program

Collaborative Model for School Health in Pitts County, North Carolina

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Healthy People 2020

Many objectives are directed toward the health of children.

Several point directly at the care that nurses give to children in the schools. These objectives are concerned with: Children with disabilities in the schools Number of children with major health problems Ratio of nurses to children in the schools

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Levels of Preventions in Schools

Primary PreventionSecondary Prevention

Tertiary Prevention

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Primary Prevention

Teaching health promotion concepts in the classroom For students and teachers Substance abuse and disease prevention education

Preventing childhood injuries Safe Kids Campaign

Preventing substance abuse behaviors Reducing the risk of the development of chronic

diseases Monitoring the immunization status of children

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Secondary Prevention

Caring for ill or injured students and school employees

Nursing care for emergencies in the school Emergency plan Emergency equipment in the school nurse’s office

Giving medications in school Assessing and screening children at school

Vision, hearing, height, weight, oral health, tuberculosis, scoliosis

Pediculosis screening Identification of child abuse or neglect

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Secondary Prevention, Cont’d

Communicating with health care providers Efforts to prevent suicide and other mental

health problems Violence at school

Six characteristics of a student who may be thinking about inflicting violence

School crisis teams

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Tertiary Prevention

IEPs for students with long-term health needs Children with asthma Children with diabetes mellitus Children who are autistic or have ADHD Children with special needs in schools Children with DNR orders Homebound children Pregnant teenagers and teenage mothers

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Controversies in School Nursing

Sex education Reproductive services Screening for STIs

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Ethics in School Nursing

Student or parent beliefs may conflict with the nurse’s beliefs.

Care should never be denied or ignored. Referral is a good option.

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Future Trends in School Nursing

Amount of health care given in the school is increasing.

Telehealth and telecounseling Internet use