Dr. Charlotte D. BarryFlorida Atlantic University

Christine E. Lynn College of NursingFebruary 2009

To Describe◦

History◦

Role◦

Ethics◦

Standards◦

Position Statements◦

Advocacy◦

Research Priorities

1895: Developed the Henry Street Settlement House◦

Provided nursing care to the families in need on the lower east side of New York◦

Organized a group of trained nurses who lived at the Settlement House ◦

Directed the Henry Street Visiting Nurses◦

Lead civic, educational and social reforms◦

Advocated for child labor laws, playgrounds, parks, housing, milk stations and licensure of midwives.

Made house calls

1902: Was appointed by Lillian Wald for a one month trial to four schools to demonstrate that a nurse could improve absenteeism◦

“she dresses or cleanses as the physician directs, mild cases of conjunctivitis, minor skin infections such as ring worm and the children need nor miss their class work. She then visits those who have been sent home and keeps records”

(Dock, 1902).

Enhance the lives of the children/families/and community of immigrants of New York City◦

provide treatment for contagious diseases◦

instruct in hygiene practices◦

make home visits to follow up on a child’s progress and instruct the families◦

provide care to all family members

Sanitary inspections of homesPrevention of infant mortalityOrganize Milk Stations at schools to instruct in safe handling and infant feeding Help families secure housing, jobs, food, clothing & careInstruct families in contagion and disease prevention

893 treatments were given137 home visits were made25 children returned to schoolLina Rogers was permanently hired 12 additional nurses were hired27 more nurses the were hired the next year98% of children excluded from school for contagious diseases returned to school

1909: the successful role of the school nurses was expanded to ◦

Atlanta◦

Boston◦

Cleveland◦

Los Angeles◦

Philadelphia◦

Seattle

Illuminates the past and energizes the future with compassion and responsiveness to the call from the community to provide nursing care that is◦

Community based◦

Holistic◦

Respectful◦

Helpful◦

Transformative

WoldPublic HealthCommunity Health

School nursing is a specialized practice of professional nursing that advances the well-being, academic success, and life-long achievement of students (NASN).

Maintains Clinical KnowledgeUnderstands Nursing ProcessAssesses health needsProvides care for acute and chronic health problemsTriagesEvaluates outcomes of care

Potential for health teaching to maintain health, prevent disability and promote wellness to students, staff, families and communities◦

informal teaching and modeling ◦

formal teaching programs for parenting teens ◦

health education material to support teachers◦

formal

inservice: TB, head lice, OSHA, first aid

◦

Curriculum planning and

developemnt

Share specific knowledge with school communityAssess need for servicesEvaluate servicesInforms on laws, consults with faculty to normalize learning environment for studentsDevelop and implement policyConsults with faculty on health curriculum Consults with primary providers and family

Forms partnerships with families, health care providers, community agencies, law enforcement, EMS, social service agencies, religious groups and others to try and reduce the effect of social conditions on the health of children.◦

Poverty, no access to care, abuse, eating disorders, self esteem, violence, car safety, after school care, sexual activity, emotional problems

Speaks out on health issues affecting students, school, communityRecognizes and supports linkages between educational goals and health: a hungry, sick, scared child cannot fully participate in the learning experienceLocal, regional, national, global levels

Children with special needs, at risk◦

pregnant teens◦

HIV/AIDS◦

ESE◦

obese◦

transplantation◦

traumatic brain injured◦

asthma

Mandated health screenings: vision, hearing, scoliosis, height & weight, BMI

Others as developed by nurse or school health planners: hypertension, diabetes, obesity, cholesterol, occult blood, TB, lead, dental caries and disease

The school nurse takes the lead in this effortFocus not on emergencies but on well childrenAppropriate personnel must be trained to respond: CPR, First Aid, emergency insect bites, anaphylaxis, universal precautions, use of protective equipment, how to activate EMS

Aggregates are groups of persons within a population possibly at risk.◦

Faculty: nutrition, activities, hypertension, stress, occupational hazards, drug safety◦

students at risk: known medical condition or potential for engaging in risky behaviors such as sex, drugs, alcohol, violence,.◦

Needs must be assessed, and program valued

Primary prevention of physical, emotional and or social health problems

Secondary prevention of physical, emotional and or social health problems

Tertiary prevention of physical, emotional and or social health problems

Promote health and welfareProtect from specific health and safety hazards. ◦

health education◦

program evaluation◦

immunizations, vaccines◦

consultation◦

adapt environment for specific needs

To facilitate early identification of health problemsTo provide/facilitate prompt intervention To prevent complications◦

screenings◦

assessments◦

management, referral, first aid, CPR, crisis counseling

To promote rehabilitation and maximizeadaption◦

reeducation◦

reorientation◦

motivation◦

secure special services◦

health programming◦

support and guidance

Preamble: Acknowledging the diversity of the laws and conditions under which school nurses practice, NASN believes in a commonality of moral and ethical conduct.

1. Client CareThe school nurse is an advocate for students, families and members of the school community. To that end, school nurses facilitate positive responses to normal development, promote health and safety, intervene with actual and potential health problems, provide case management services, and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning. Each individual's inherent right to be treated with dignity and confidentiality is respected. All clients are treated equally regardless of race, gender, socio-economic status, culture, age, sexual orientation, disability or religion. Interpretive StatementsA. School nurses deliver care in a manner that promotes and preserves student and family autonomy, dignity and rights.B. School nursing services support and promote individuals' and families' ability to achieve the highest quality of life as understood by each individual and family.C. School nurses deliver care in a nonjudgmental and nondiscriminatory manner that is sensitive to student diversity in the school community.D. School nurses maintain student confidentiality within the legal, regulatory and ethical parameters of health and education.

2. Professional CompetencyThe school nurse maintains the highest level of competency by enhancing professional knowledge and skills, and by collaborating with peers, other health professionals and community agencies while adhering to the Standards of School Nursing Practice.Interpretive StatementsA. The profession of nursing is obligated to provide competent nursing care. The school nurse must be aware of the need for continued professional learning and must assume personal responsibility for currency of knowledge and skills.B. School nurses must evaluate their own nursing practice in relation to professional practice standards and relevant statutes, regulations and policies.C. It is necessary for school nurses to have knowledge relevant to the current scope of practice. Since individual competencies vary, nurses consult with peers and other health professionals with expertise and recognized competencies in various fields of practice. When in the client's best interest, the school nurse refers clients to other health professionals and community health agencies.D. Nurses are accountable for judgements made and actions taken in the course of nursing practice. Professional Standards of School Nursing Practice reflect a practice rounded in ethical commitment. The school nurse is responsible for establishing and maintaining a practice based on these standards.

3. Professional ResponsibilitiesThe school nurse participates in the profession's efforts to advance the standards of practice, expand the body of knowledge through nursing research and improve conditions of employment.Interpretive StatementsA. The school nurse is obligated to demonstrate adherence to the profession's standards by monitoring these standards in daily practice, participating in the profession's efforts to improve school health services and promoting student health and academic success.B. The school nurse utilizes available research in developing the health programs and individual plans of care and interventions.C. The school nurse participates in and promotes research activities as a means of advancing school health services and the health of students. This is done as appropriate to the nurse's education, position and practice environment and in adherence to the ethics that govern research, specifically:

1) Right to privacy and confidentiality,2) Voluntary and informed consent and3) Awareness of and participation in the mechanisms available to address violations of the rights of human subjects.

D. The school nurse recognizes that conditions of employment impact the quality of client care and is cognizant of the need to work with others to improve these conditions.

The school nurse is an advocate for students, families and members of the school community; facilitate positive responses to normal development, promote health and safety, intervene with actual and potential health problems, provide case management services, and actively collaborate with others to build student and family capacity for adaptation, self-

management, self-advocacy, and learning. Each individual's inherent right to be treated with dignity and confidentiality is respected. All clients are treated equally regardless of race, gender, socio-economic status, culture, age, sexual orientation, disability or religion.

A. School nurses deliver care in a manner that promotes and preserves student and family autonomy, dignity and rights.B. School nursing services support and promote individuals' and families' ability to achieve the highest quality of life as understood by each individual and family.C. School nurses deliver care in a nonjudgmental and nondiscriminatory manner that is sensitive to student diversity in the school community.D. School nurses maintain student confidentiality within the legal, regulatory and ethical parameters of health and education.

The school nurse maintains the highest level of competency by enhancing professional knowledge and skills, and by collaborating with peers, other health professionals and community agencies while adhering to the Standards of School Nursing Practice.

A. The profession of nursing is obligated to provide competent nursing care. The school nurse must be aware of the need for continued professional learning and must assume personal responsibility for currency of knowledge and skills.B. School nurses must evaluate their own nursing practice in relation to professional practice standards and relevant statutes, regulations and policies..

C. It is necessary for school nurses to have knowledge relevant to the current scope of practice. Since individual competencies vary, nurses consult with peers and other health professionals with expertise and recognized competencies in various fields of practice. When in the client's best interest, the school nurse refers clients to other health professionals and community health agencies.D. Nurses are accountable for judgements made and actions taken in the course of nursing practice. Professional Standards of School Nursing Practice reflect a practice rounded in ethical commitment. The school nurse is responsible for establishing and maintaining a practice based on these standards

3. The school nurse participates in the profession's efforts to advance the standards of practice, expand the body of knowledge through nursing research and improve conditions of employment.

A. The school nurse is obligated to demonstrate adherence to the profession's standards by monitoring these standards in daily practice, participating in the profession's efforts to improve school health services and promoting student health and academic success.B. The school nurse utilizes available research in developing the health programs and individual plans of care and interventions.

C. The school nurse participates in and promotes research activities as a means of advancing school health services and the health of students. This is done as appropriate to the nurse's education, position and practice environment and in adherence to the ethics that govern research, specifically:

1) Right to privacy and confidentiality,2) Voluntary and informed consent and3) Awareness of and participation in the mechanisms

available to address violations of the rights of human subjects.D. The school nurse recognizes that conditions of employment impact the quality of client care and is cognizant of the need to work with others to improve these conditions.

Standard 1. AssessmentStandard 2. DiagnosisStandard 3. Outcomes IdentificationStandard 4. PlanningStandard 5. Implementation

Standard 5a. Coordination of CareStandard 5b. Health Teaching and

Health PromotionStandard 5c. ConsultationStandard 5d. Prescriptive Authority

and TreatmentStandard 6. Evaluation

The school nurse uses a distinct clinical knowledge base for decision making in nursing practice.Courses include community health, public health, school health administration, growth and development, communication skills, advanced first aid, psychology, and sociology.

The school nurse uses a systematic approach to problem solve in nursing practice.Nursing process: ◦

Assessment◦

Diagnosis◦

Planning◦

Implementation ◦

Evaluation

The school nurse contributes to the education of the client with special health needs by assessing, planning and providing appropriate care, and evaluating the identified outcomes of care.◦

Children with disabilities◦

Pregnant and parenting teens◦

Children at risk

The school nurse used effective written, verbal and nonverbal communication skills.◦

Health messages to persons across the life span◦

Determine interest in subject◦

Language barriers◦

Hearing and vision impaired◦

Messages that inform and calm◦

Document care: observed, objective, through

The school nurse establishes and maintains a comprehensive school health program and contributes to policy development◦

health services: assessment, screening, meds, referrals, documentation, compliance with laws such as immunizations and physicals, first aid. ◦

health education: health promotion, prevention◦

environmental: sanitation, safety, asbestos, mold, violence, apathy, food services, smoke free/drug free, modifications to accommodate.

The school nurse collaborates with others to to meet the health, developmental, and educational needs of students.◦

School administrators, faculty, staff◦

parents◦

caregivers◦

members of Core Team, ESE team, safety committee, SAC, SHAC, PTA,

PTOs

The school nurse collaborates with members of the community in the delivery of health care and utilizes knowledge of community system and resources to function as a school-community liaison.◦

Local hospitals, private providers, health department, school district: ESE, 504, safety, environment, ITV, American Red Cross, Lung, Cancer, & Heart, university, volunteers

The school nurse assists students, families, and the school community to achieve optimum levels of health through appropriately designed and delivered health education. ◦

based on assessment◦

sensitive to needs◦

easily understood message◦

complete and accurate information

The nurse contributes to the discipline of knowledge and school nursing practice through innovations in practice and participation in research and research related activities.◦

Incidence of hypertension in youths◦

safety interventions to reduce incidence◦

prevention programs for tobacco, alcohol & drugs

The school nurse identifies, delineates and clarifies the nursing role; promotes quality of care; pursues continued professional development; and demonstrates professional conduct.◦

Continuing ed.◦

Advanced degrees: BSN, MSN, SNP (school nurse practitioner.◦

Certifications: RN’s acknowledged for expertise in special area of practice

Assessment involves collecting, organizing, validation and recording data about the student’s health status.◦

Objective data include signs that are observable, detectable and measured: such as: immunizations records, vital signs, breath sounds, skin lesions, screening results, pupil responses.

Subjective: includes data reported by the client. These include: symptoms, sensations, feelings, values, perceptions of current health status. These symptoms are reported by students, parents, faculty, friends. Frequently heard symptoms are complaints of discomfort, fears and anxiety.

Data Collection:◦

problems◦

risk for injury◦

potential for self care◦

health education needs◦

current and past functional status◦

present and past coping skills◦

desire for a higher health status

Two types of assessment: Screenings and Focus Assessments◦

Screening: gather broad and general data helps you focus on potential problem and examine more specifically.◦

Focus assessment: is designed to elicit more specific information: ask what, where, why, when, how. ◦

STUDENTS RICHEST SOURCE OF DATA

Process of analyzing data and forming a conclusion is the diagnostic component of the nursing process.◦

Identifies relationships of patterns of health or disease

no diagnosis at this timecollaborative problem statementactual, risk, possible, syndrome, or wellness nursing diagnosis

Plan of care that will prevent, reduce, stabilize or eliminate students health problems.◦

Set priorities (high risk, altered breathing etc.)◦

Set goal with student and or family◦

Select nursing intervention◦

Collaborate with student and or family

The nursing care plan is carried out with action◦

The student and or family participate◦

While intervention is unfolding, assessment continues◦

Redesign takes place as necessary

Compare current health status with expected outcomes and determine how much progress has been made toward achievement.◦

Evaluation is ongoing ◦

Student and family is involved◦

Outcome is determined collaboratively

55 statements: from A to VAnimals in the Classroom Disaster PlanningRole of ARNP’sSupporting Pregnant TeensTelehealthVolunteering

Goal 1: Improve the reliability, quality, and accessibility of school health data to promote research and knowledge development in child health and school health.

Goal 2: Advance research and development of effective, evidence based models of school health services delivery in order to create consensus among school nurse leaders and health policy makers on what constitutes a quality school health services program.

Goal 3: Discover the critical indicators that are sensitive enough to distinguish between the effects of family and community and the effects of school nursing interventions on child, family and school community outcomes.

Goal 4: Solidify NASN’s as the authority on evidence based school nursing practice.

Look at web site for issuesChildren’s HealthSchool Nurse RatioSchool based Health Centers

◦

American School Health Association

(1991). Implementation Guide for the Standards of School Nursing Practice. American School Health Association. Publications: Kent, Ohio. Hawkins, J.W., Hayes, E. R. &

Corliss, P. (1994). School nursing in America-

1902-1994: A return to public health. Public Health Nursing 11(6), 416-425.

5

Jossens, M.

Ferjancik, P. (1996). Of Lillian

Wald, Community health nursing education, and health care reform. Public health Nursing 13 (2), 97-103

5

National Association of School Nurses (1998). Standards of Professional School Nursing Practice.

Scarborough, Maine: NASN

National Association of School Nurses (1999). Code of Ethics with Interpretative Statements for the School Nurse. Scarborough, Maine: NASN Publication.

◦

Rogers, L. (1903). School nursing in New York City. American Journal of Nursing (3), 448-450. ◦

Rogers, L. (1905). The nurse in public schools. American Journal of Nursing 5 (11), 764-773.

Selekman, J. (Ed.). (2006). School Nursing: A comprehensive text. Philadelphia: FA Davis.Selekman, J. & Wolfe, L. (2008). School

Nursing Certification Review. Md. NASN

Wold, S. (1981). School Nursing: A Framework for Practice. Sunrise River Press: Minnesota.

Wald, L. (1902). The school nurse in New York City. American Journal of Nursing 3 (2), 221-222.Woodfill, M & Beyer, M. (1991). The role of the nurse in the school setting: An historical perspective. American School Health Association Publication