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School Health Services:School Health Services:

Promoting and Protecting Student Promoting and Protecting Student HealthHealth

Chapter 2Chapter 2

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School’s Role in Providing School School’s Role in Providing School Health ServicesHealth Services

School Health ServicesSchool Health Services provide the following for provide the following for students and school personnelstudents and school personnel AppraisalAppraisal ProtectionProtection PromotionPromotion

Services are offered by teachers and allied Services are offered by teachers and allied health professionalshealth professionals

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School’s Role in Providing School School’s Role in Providing School Health Services, cont.Health Services, cont.

A system of referring students and families to A system of referring students and families to agencies and health professionals with careful agencies and health professionals with careful follow up is the follow up is the key componentkey component

Follow upFollow up is necessary to make sure the is necessary to make sure the intended services were rendered and properly intended services were rendered and properly recordedrecorded

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Teacher’s Role withTeacher’s Role withHealth ServicesHealth Services

Observation of students behavior, appearance, or Observation of students behavior, appearance, or expressionsexpressions

Detect students’ needsDetect students’ needs Offer supporting role even in emergenciesOffer supporting role even in emergencies Intervene when necessaryIntervene when necessary

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School Nurse Role withSchool Nurse Role withHealth ServicesHealth Services

Advocate for staff and students, considered the Advocate for staff and students, considered the “cornerstone” of health services“cornerstone” of health services

Roles also include:Roles also include: Care providerCare provider Change agentChange agent EducatorEducator TherapistTherapist ManagerManager

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Responsibilities of School NursesResponsibilities of School Nurses

Maintain health records and Maintain health records and historieshistories

Interpret results of Interpret results of appraisalsappraisals

Identify health concernsIdentify health concerns Provide information to Provide information to

school personnelschool personnel Perform health screeningsPerform health screenings

Train other school Train other school personnel who often must personnel who often must assume responsibilities for assume responsibilities for school health servicesschool health services

Help students seek Help students seek appropriate help for appropriate help for personal issuespersonal issues

Initiate referrals to parents, Initiate referrals to parents, school personnel, etcschool personnel, etc

Provide emergency care for Provide emergency care for injuries/illnessesinjuries/illnesses

Administer medicationsAdminister medications Control communicable Control communicable

diseases through a variety diseases through a variety of methodsof methods

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Responsibilities of School Nurses, cont.Responsibilities of School Nurses, cont.

Provide appropriate Provide appropriate counseling to parents, counseling to parents, students, etc.students, etc.

Participate as the health Participate as the health team specialist on the child team specialist on the child education evaluation team education evaluation team to develop individual to develop individual education planseducation plans

Initiate health management Initiate health management procedures for children procedures for children with special needswith special needs

Assist in the formulation of Assist in the formulation of health policies for the health policies for the school/districtschool/district

Conduct evaluations of Conduct evaluations of school health services to school health services to improve servicesimprove services

Serve as a resource to Serve as a resource to students interested in students interested in pursuing a health careerpursuing a health career

Provide health educationProvide health education

The American Nursing Association recommends 1 school nurse for every 750 students

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School Health AidesSchool Health Aides

School districts employ health aides to assist the school School districts employ health aides to assist the school nursenurse

Provides a variety of tasks, administrative as well as Provides a variety of tasks, administrative as well as basic first aidbasic first aid

Health Aides need to be knowledgeable about many Health Aides need to be knowledgeable about many health topics and standardshealth topics and standards

The scope of practice of a School Health Aide is The scope of practice of a School Health Aide is limited limited and is and is under the supervision of the school nurseunder the supervision of the school nurse

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Confidentiality ofConfidentiality ofStudent Health InformationStudent Health Information

Family Education Rights and Privacy ActFamily Education Rights and Privacy Act Establishes confidentiality of all students’ information, Establishes confidentiality of all students’ information,

records, and rights of parents to access thisrecords, and rights of parents to access this Families do not have to disclose certain health Families do not have to disclose certain health

conditions to school staff (i.e., HIV status)conditions to school staff (i.e., HIV status) School staff need to be trained in requirements of School staff need to be trained in requirements of

state law and school policiesstate law and school policies Health Insurance Portability and Accountability Health Insurance Portability and Accountability

ActAct Sets standards for the privacy of identifiable health Sets standards for the privacy of identifiable health

informationinformation

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Community PartnershipsCommunity Partnerships

Can increase capacity to offer more health Can increase capacity to offer more health servicesservices

The degree of services are dependent upon The degree of services are dependent upon needsneeds of the students of the students

Full service schools involve the following:Full service schools involve the following: Educational, social, and health services Educational, social, and health services

deliverydelivery Improve the quality of life for Improve the quality of life for

individuals/familiesindividuals/families

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School Based Health CentersSchool Based Health Centers

Provide on-site comprehensive health care for Provide on-site comprehensive health care for young students you cannot receive adequate young students you cannot receive adequate carecare

Easily accessible location on school premisesEasily accessible location on school premises Becomes the sole source of health care for Becomes the sole source of health care for

many young studentsmany young students Such centers exist in only 2% of all U.S. schoolsSuch centers exist in only 2% of all U.S. schools

Lack of access is cited as the major reason for proliferation of these centers

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Support for School Based Health Support for School Based Health CentersCenters

Health care services is costly, however, there Health care services is costly, however, there are strong arguments in support of the school-are strong arguments in support of the school-based centersbased centers

School based clinics have reduced the visits to School based clinics have reduced the visits to the ERthe ER

Cuts health care costs for poor childrenCuts health care costs for poor children Lowers the number of STD’s (Lawson, 2000)Lowers the number of STD’s (Lawson, 2000)

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Accommodations forAccommodations forSpecial StudentsSpecial Students

Rights of students with disabilities are protected (Section Rights of students with disabilities are protected (Section 504/Rehabilitation Act of 1973)504/Rehabilitation Act of 1973)

Schools must make provisions to accommodate the special Schools must make provisions to accommodate the special needs of studentsneeds of students

Written plans must state the child’s disability or impairment, Written plans must state the child’s disability or impairment, needs, and how these accommodations will be metneeds, and how these accommodations will be met

Teachers may be responsible for administering these services Teachers may be responsible for administering these services (i.e., administering medications)(i.e., administering medications)

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School-Based Mental Health ServicesSchool-Based Mental Health Services

The American Academy of Pediatrics advocates that school The American Academy of Pediatrics advocates that school personnel work with pediatric health care professionals and mental personnel work with pediatric health care professionals and mental health specialists to develop and implement effective school-based health specialists to develop and implement effective school-based mental health servicesmental health services

The proportion of child and adolescent needing care and assistance The proportion of child and adolescent needing care and assistance for psychosocial problems has increased substantially in recent for psychosocial problems has increased substantially in recent yearsyears

20% of children have mental health problems requiring mental 20% of children have mental health problems requiring mental health interventionshealth interventions

School based programs can improve access to these interventionsSchool based programs can improve access to these interventions

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Administration of Medications at SchoolAdministration of Medications at School

A written order must be from a family physician that identifies the A written order must be from a family physician that identifies the following:following:

DoseDose TypeType Time of administrationTime of administration PurposePurpose Side effectsSide effects

An emergency care plan should be developed for students who An emergency care plan should be developed for students who might require the administration of emergency medications by might require the administration of emergency medications by injectioninjection

Parents are responsible for supplying and informing the school of Parents are responsible for supplying and informing the school of any changes with the medication or childany changes with the medication or child

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Administration of Medications at Administration of Medications at School, cont.School, cont.

Strict statements are required regarding who Strict statements are required regarding who administers the medicationadministers the medication

Record keeping is essential by the school nurse or Record keeping is essential by the school nurse or designated persondesignated person

The most common medication dispensed are for ADHD The most common medication dispensed are for ADHD (Attention Deficit Hyperactivity Disorder)(Attention Deficit Hyperactivity Disorder)

Field trips will require an action plan with regards to medication administration

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Emergency Care in SchoolsEmergency Care in Schools

Schools must be prepared for students and staff Schools must be prepared for students and staff becoming injured or ill on a daily basisbecoming injured or ill on a daily basis

Emergency step procedures must be set up and in place Emergency step procedures must be set up and in place Every employee must know their role/scope when an Every employee must know their role/scope when an

emergency arises through proper training/emergency emergency arises through proper training/emergency response planresponse plan

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Emergency Care in Schools (cont’d)Emergency Care in Schools (cont’d)

Individual students need to be recognized who have specific health Individual students need to be recognized who have specific health conditions that can lead into an emergency situationconditions that can lead into an emergency situation

An Emergency First Aid kit should be current and accessibleAn Emergency First Aid kit should be current and accessible Understand limitations and scope of one’s abilities (i.e., DNR and Understand limitations and scope of one’s abilities (i.e., DNR and

information provided, first aid manual)information provided, first aid manual) Parents/Guardians will need to be notified when a child has been Parents/Guardians will need to be notified when a child has been

injured/become ill at schoolinjured/become ill at school Proper forms need to be documented to protect against liabilityProper forms need to be documented to protect against liability

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Do-Not-Resuscitate OrdersDo-Not-Resuscitate Orders

(DNR) orders instruct school personnel to (DNR) orders instruct school personnel to make no effort to resuscitate a child who make no effort to resuscitate a child who appears to be dying and not to call appears to be dying and not to call emergency medical services (EMS)emergency medical services (EMS)

School officials are not in favor of DNR School officials are not in favor of DNR orders, arguing that schools do not applyorders, arguing that schools do not apply

It is best to consult with your local school It is best to consult with your local school district to understand if DNR orders are district to understand if DNR orders are legallegal

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School Health Services:School Health Services:

Promoting and Protecting Student Promoting and Protecting Student HealthHealth

Chapter 2Chapter 2