Chapter 18:
Health Planning for
School Settings
Learning Outcomes
1.
Define school nursing.
2.
Present the contributions of school health to the achievement of Healthy
People 2020 objectives.
3.
Describe the components and tenets of the student-centered Whole
School, Whole Community, Whole Child model.
4.
Summarize the key principles of the 21st Century Framework for School
Nursing Practice.
5.
Discuss the role of school nurses in addressing health disparities and
social determinants of health among vulnerable students.
6.
Describe the role of policy in understanding school nursing practice.
7.
Discuss challenges to school health nursing for the future.
School Nursing
Specialized practice that, for
students, advances:
○
Well-being
○
Academic success
○
Lifelong achievement
○
Health*
 Promote health and safety
 Provide case management
 Intervene when actual and
potential health problems arise
 Serve as advocates
 Promote self-management
*National Association of School Nurses. (2017). Definition of School Nursing. Retrieved from https://www.nasn.org/nasn/about-nasn/about.
Activities of School Nurses
Provides individual and
population-based care
through:






Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation_
School Nursing Functions
● School nurses function in two worlds
Health
Education
● Nurses need to know both education and health:
○
Priorities
○
Goals
○
Policies
○
Legal requirements
in the implementation of school health services
● Have a role as coordinators and connectors in the school setting
● Code of ethics for school nurses focuses on:
○
Client care
○
Professional advocacy
○
Professional responsibilities**
History of School Nursing (continued)
 Beginning of 20th century Lilian Wald collaborates with NYC Board of
Education and Board of Health. High number of absenteeism and medical
exclusions**
 October 1, 1902, Lina Struthers experimented as a month-long school
nurse for NY schools
 December 1902, ADPIE leads to more school time for children. Struthers
becomes superintendent. School nurses increase from 1 to 12
 School nursing spreads throughout US and Canada
Beginning of
20th century
December
1902
October
1902
Student health-related exclusions drop by 90%
from 10,567 students to 1,101 students
October
1903
Healthy People
Healthy People 2020 (HP 2020):
Early & middle
childhood health
Adolescent health
 Topics that are emphasized:


The link between early childhood and adolescent behavior
patterns and adult health
The role of the school setting in promoting health
Coordinated school health program
Set of planned, sequential, schoolaffiliated strategies, activities, and
services based on promoting the
optimal social, physical, emotional, and
educational development of students**
 Four main supportive structures
1.
School health advisory council
2.
School health coordinator
3.
School-based health teams
4.
School board policy
*Centers for Disease Control and Prevention. (2015b). Components of a coordinated school health program. Retrieved from http://www.cdc.gov/healthyyouth/ cshp/components.htm.
Whole School, Whole Community, Whole Child
(WSCC) Model**
Five Tenets of WSCC
1.
[The student] enters school healthy and learns about and
practices a healthy lifestyle
2.
Learns in an environment that is physically and emotionally safe
for students and adults
3.
Is actively engaged in learning and connected to the school and
broader community
4.
Has access to personalized learning and is supported by qualified,
caring adults
5.
Is challenged academically and prepared for success in college,
further study, employment, and participation in a global
environment**
WSCC Components
Health education
Physical education/activity
Nutrition environment and services
Health services
Counseling, psychological & social services
Physical environment
Employee wellness
Family engagement
Community involvement
Social & emotional climate
Framework for 21st-Century School Nursing
Practice
Framework for 21st-Century School Nursing
Practice (continued)
Interventions in a School’s Population
Surveillance & _vaccination_
Outreach to immigrant_ populations
Health _screening
episodic care
Immunizations
o Monitor vaccinations to
assure compliance with
state mandates using state
immunization information
systems***
o Counsel families and staff
o
about immunizations across
the lifespan
Vaccinations can be
administered by school
nurses or public health
department staff members
Willgerodt, M.A., Brock, D. M., & Maughan, E.M. (2018). Public school nursing practice in the United States. Journal of School Nursing, 34(3), 232-244. doi.org/10.1177/1059840517752456
Sexuality and Sex Education
•
•
Primary prevention of highrisk behaviors related to
sexuality is a priority for
school populations.
 39.5% of high school students
have had sexual intercourse.***
Sex education: school
nurses take into
consideration cultural and
environmental issues
specific to their schools and
students***
*Centers for Disease Control and Prevention. (2017). Youth Risk Behavior Surveillance—United States 2016. Morbidity and Mortality Weekly Report, 67(8).
Violence Prevention
● Bullying: unwanted aggressive behavior by youth
toward another youth who is not a sibling or dating
partner*
 Include cyberbullying**
 School nurses have a role in prevention, early identification
and treatment, related to bullying, cyberbullying, and
violence.
 Olweus Bullying Prevention Program***
*Gladden, R.M., Vivolo-Kantor, A.M., Hamburger, M.E., & Lumpkin, C.D.(2014). Bullying Surveillance Among Youths: Uniform Definitions for Public Health and Recommended Data Elements, Version 1.0. Atlanta, G A; National Center for Injury Prevention and Control, Centers for Disease
Control and Prevention and U.S. Department of Education. Retrieved from https://www.cdc.gov/violenceprevention/ pdf/Bullying-Definitions-FINAL-a.pdf
Dating Violence
● Of the 68.3% of U.S. high school students who date:
○ 6.9% described being forced to participate in unwanted sexual
activities
○ 8% experienced intentional injury**
● Nurses need to screen adolescents for teen dating violence,
especially those with high-risk behaviors**
Outreach to Immigrant Populations
● The percentage of children
living in the US with at least
one foreign-born parent rose
from 15% in 1994 to 25% in
2016
● Challenge: cultural
differences, poverty, lack of
health insurance, lack of
public assistance, limited
English proficiency, and high
levels of psychological
distress (war or adverse
events)
● Nurses can perform
_______________ to these
population
Health Screening of Children and
Adolescents
School nurses regularly
conduct health screening
including:
 Vision (Snellen chart)
 Audiometric
 Obesity
Life-Threatening
Emergencies
Cardiac arrest
Overdose
Head injuries
Heat stroke
School-based
violence
● Food allergies**
●
●
●
●
●
Episodic Care in
the School Setting
•
•
•
•
•
Asthma
Cancer
Diabetes
Allergies
Mental health
disorders
Components of Care Coordination
1.
School health care teams
2.
Interagency partnerships
3.
Documentation with
electronic health records
4.
Clinical expertise and
evidence-based
guidelines
5.
Performance
improvements and
outcome evaluation
*Baker, D., Anderson, L., & , Jonson, J. (2017). Building student and family-centered care coordination through ongoing delivery system design: How school nurses can implement care coordination. NASN School Nurse,32(1), 42-49. doi.org/10.1177/1942602X16654171
Children with Disabilities
● Child With a Disability: (A) In general.—The term “child with a
disability” means a child—(i) with mental retardation, hearing
impairments (including deafness), speech or language impairments,
visual impairments (including blindness), serious emotional
disturbance (referred to in this title as ‘emotional disturbance’),
orthopedic impairments, autism, traumatic brain injury, other health
impairments, or specific learning disabilities; and (ii) who, by reason
thereof, needs special education and related services.”
Children with Disabilities
May need:
● School health services: medication, treatment, emergency care
plans, individualized care plans, health teaching, & health
counseling
● Safe and healthy environment: special furniture, elevators,
restroom, wheelchair access, restroom accommodation, tube
feedings, or rest.
Disability laws
● Education for All Handicapped Children Act (EAHCA) of 1975
○
Federal funding to states for provision of least restrictive
environment
● Individuals with Disabilities Education Act (IDEA)
○
○
Individualized education program (IEP)*
Individualized family service plan (IFSP)*
● Americans with Disability Act*
Mental Health Disorders
● 13% have a MHD
○ ADHD the most common at around 10%**
● The school nurse can
1. Monitor school-based mental health care
2. Act as a care coordinator
3. Advocate for the student
4. Act as a liaison between the family, school, clinic, and
primary provider
● Develop an Individualized Healthcare Plan for
children with identified mental health needs
*Bloom, B., Cohen, R.A., & Freeman, G. (2013). Summary health statistics for U.S. children: National Health Interview Survey 2012. National Center for Health Statistics. Vital Health Statistics, 10(258). Retrieved from https://www.cdc.gov/nchs/data/series/sr_10/sr10_258.pdf
Consultation
● School nurses provide
consultation within
schools to address
health issues.
● Can be for
individualized education
program evaluations
such as the 504 plan**
● 39 states have a state
school nurse
consultant
Advocacy
● Advocates for the
student population and
their families through
efforts to influence policy
at the local, state, and/or
national levels
● A direct advocate for
health-care consumers,
in this case, the students,
families, and school
communities
Policy Development and Enforcement
●Local Laws and Regulations:
○ Local and school wellness policies
●State Laws and Regulations:
○ Nurse practice acts and codes
○ immunizationn and student screening regulations
●Federal Laws and Regulations
○
○
○
○
Elementary and Secondary Education Act (ESSA)
Child Abuse Prevention and Treatment Act (CAPTA)
Children’s Health Insurance Program (CHIP)
Healthy Hunger Free Kids Act